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Introduction, the original positive psychology, potential mechanisms linking positive phenomena with positive health outcomes, pervasive and limiting assumptions about positive beliefs and states, a prescription for advancing science and practice, while avoiding the “tyranny of optimism”, acknowledgments.

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The Value of Positive Psychology for Health Psychology: Progress and Pitfalls in Examining the Relation of Positive Phenomena to Health

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Lisa G. Aspinwall, Richard G. Tedeschi, The Value of Positive Psychology for Health Psychology: Progress and Pitfalls in Examining the Relation of Positive Phenomena to Health, Annals of Behavioral Medicine , Volume 39, Issue 1, February 2010, Pages 4–15, https://doi.org/10.1007/s12160-009-9153-0

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The growth of the “positive psychology” movement reflects increased scientific and lay interest in the relation of positive phenomena to mental and physical health and the corresponding potential for interventions that promote positive feelings, thoughts, and experiences to improve health and well-being. In this article, we (1) consider research on optimism, sense of coherence, and posttraumatic growth that predates the contemporary emphasis on positive psychology, but has clear and increasingly well-supported connections to health psychology, (2) examine several potential mechanisms through which such positive phenomena may influence the etiology, progression, and management of illness, (3) identify four pervasive but misleading assumptions about positive phenomena that may limit both scientific research and practical application, and (4) caution against serious pitfalls of popular views of positive thinking, such as its promotion as a cure for cancer and other diseases. We conclude with recommendations for the balanced scientific investigation and application of positive phenomena.

The explosion of research on “positive psychology” includes multiple theoretical and research areas that share a common focus on positive human functioning, psychological health, and adaptation to illness and other forms of adversity [ 1 – 5 ]. Although many of these lines of research predate the use of the term “positive psychology” [ 2 ], this increased emphasis on positive phenomena has generated a corresponding upswing in scientific and lay interest in such topics as positive affect, meaning, mastery, personal growth, forgiveness, gratitude, hope, optimism, and spirituality, their relation to mental and physical health, and their potential for applications to promote well-being and health.

When we consider the contribution of these perspectives to health psychology, we find many ideas that may lead to interventions that promote healing and health. In this article, we (1) consider research on such concepts as optimism, meaning, and growth that predate the current emphasis on positive psychology, but have clear and increasingly well-supported connections to health psychology, (2) examine multiple mechanisms through which these and other positive phenomena may be related to health outcomes, including the etiology, progression, and management of illness, (3) identify pervasive but misleading assumptions about positive beliefs and states that may limit both scientific research and practical application, and (4) outline strategies for avoiding some pernicious popular views of positive thinking in order to pursue the balanced scientific investigation and application of positive phenomena to promote human health and well-being. This article is not an exhaustive review of any of these issues, but rather an illustrative one that we hope will contribute to the ongoing debate about the value of positive phenomena for promoting health and managing illness.

Much of the work that may be considered to fall within “positive psychology” originated before the use of the term in 2000 when Seligman and Csikszentmihalyi [ 2 ] organized the field around three themes: positive experience, positive personality, and positive communities and institutions. Psychologists have long been concerned with understanding how people respond to adversity (captured by such concepts as adaptation, resilience, thriving, and growth [ 6 – 9 ]) and whether particular personal, social, and developmental factors may be protective of long-term mental and physical health [ 10 – 14 ]. Some key contributions to this effort—notably, cognitive adaptation theory [ 6 ] and dispositional optimism [ 15 , 16 ]—originated within health psychology itself in studies of diseases such as breast cancer and heart disease. It is beyond the scope of this article to review many of the positive psychology constructs that are related to health, so we will consider some representative and well-developed areas of study: sense of coherence [ 9 , 17 ], optimism [ 15 , 16 ], and benefit-finding and posttraumatic growth [ 18 – 20 ]. In each case, health psychology has already benefited from these perspectives and the field is likely to draw on them in useful ways in the future. We will highlight some of the work that makes this case. However, we caution that we should not conceptualize these variables that have a “positive flavor” as contained within something we call positive psychology. If we divide the world into positive psychology and not and designate specific concepts as “positive” or “negative,” we may create artificial barriers in our communications, the development of our theoretical models, and our decisions about variables to include in our research and interventions (cf. [ 21 , 22 ]).

Sense of Coherence

Antonovsky [ 17 ] attempted to understand the question of how some persons stay healthy while others develop stress-related disorders. The focus in this work was “salutogenic” as opposed to pathogenic, and this certainly brings it into the realm of positive psychology that was to be promoted by Seligman and others in later years. Antonovsky described three elements of sense of coherence: comprehensibility, manageability, and meaningfulness. Events that are stressful or traumatic may appear to be chaotic, random, and inexplicable and thus pose a challenge to these elements of people's lives. Events that are undesirable can be made less stressful to the degree that people can comprehend them. Events will also be less stressful, even if undesirable, if people perceive that they have the resources necessary to cope with or manage these events. The resources can be internal or they may be controlled by others who have good intentions. This leads to a belief that, somehow, the things that are happening will be tolerable. Finally, meaningfulness may be found in even the most unfortunate circumstances and certain people may be more able to approach events in a way that allows meaning to be found. Antonovsky sees meaningfulness as driving people to understand and manage events, and therefore, playing a role as the most important aspect of sense of coherence (see also [ 23 – 25 ]). It is important in order that people stay healthy for meaningfulness to be found in one or more crucial areas of life functioning: inner feelings, interpersonal relationships, one's major activity, and existential issues.

Optimism is a generalized expectancy for positive outcomes that appears to be trait-like and predicts how people cope with stress. The robust literature on optimism in relation to health psychology has been recently reviewed [ 26 , 27 ]. Dispositional optimists tend to engage more frequently in approach-oriented forms of coping, to be flexible in their use of adaptive coping strategies in regard to controllability of stressors [ 28 ], and to have greater perceived capability to manage potentially traumatic events [ 29 ]. Optimism has been associated with better coping with a variety of health problems (e.g., breast cancer [ 30 , 31 ] and human immunodeficiency virus [HIV] infection [ 32 ]). Optimism is also associated with positive health behaviors [ 32 , 33 ], better recovery from certain medical procedures [ 16 ], positive changes in immune system functioning [ 34 ], and improved survival rates [ 33 , 35 ].

Benefit-finding and Growth

Benefit-finding and posttraumatic or stress-related growth have assumed an important place in health psychology in recent years [ 36 , 37 ], and these related concepts appear to dovetail with the themes of positive psychology. Finding benefit in adversity or experiencing personal growth as one deals with the aftermath of stress and trauma has been recognized as common among people experiencing a variety of negative events, including physical illnesses (e.g., [ 38 ]). These concepts are distinct from sense of coherence or resilience, which emphasize how people resist adversity or bounce back from it [ 12 , 14 ]. Posttraumatic growth, in particular, emphasizes a transformation of people in the aftermath of traumatic events that may shatter the assumptive world of those experiencing them [ 39 ], requiring a reconceptualization of fundamental beliefs about self, others, and the future [ 9 ], producing personal growth. This growth may include a greater sense of personal strength, a greater appreciation of life, improved relationships with others, spiritual change and development, and new life opportunities [ 40 , 41 ]. A less pervasive change may also be seen in those who may not reorder their basic beliefs, but nevertheless make important changes in behaviors such as smoking and diet in the aftermath of major illness [ 42 ]. Of particular interest, a recent review of the qualitative literature on posttraumatic growth and life-threatening illness found that only 17 of the 57 studies identified specifically focused on posttraumatic growth, while the rest uncovered reports of growth rather serendipitously [ 43 ], suggesting that researchers can easily miss reports of positive changes if they do not specifically ask about them. Most of these unsolicited reports were obtained in studies of cancer patients who reported the domains of posttraumatic growth described by Tedeschi and Calhoun [ 40 ], as well as positive changes in health behaviors.

Cumulative Evidence for a Prospective Independent Link between Positive Phenomena and Multiple Health Outcomes

In order to be convinced of the value of such positive phenomena as sense of coherence, optimism, benefit-finding, and posttraumatic growth to the field of health psychology, we need data to support the relationship of these variables to favorable health status or outcomes and ways to demonstrate how any such relationships might have biological, behavioral, or social processes mediating them. Such evidence is accumulating—three recent meta-analyses have concluded that optimism and/or subjective well-being (typically assessed by measures of positive affect) have a reliable, positive, and prospective relationship to multiple short-term and long-term health outcomes in both healthy and ill samples [ 27 , 44 , 45 ]. Importantly, the relation between positive states and health outcomes is not explained by the detrimental effects of either pessimistic expectations or state or trait forms of negative affect, such as distress, depression, or anger, and the benefits associated with positive states are comparable in magnitude to the deleterious effects of these widely studied negative states [ 27 , 45 ]. With respect to studies of mortality, it is important to note that the evidence for the protective benefits of positive thoughts and feelings seems to be stronger for healthy samples than for ill samples and that the strength of the findings seems to vary by disease. In particular, specific results for cancer mortality, unlike those for cardiovascular disease, renal failure, or HIV, were either weaker [ 27 ] or nonsignificant [ 44 ].

Multiple and Potentially Interrelated Pathways Through Which Positive Phenomena May Influence Health

Researchers are increasingly recognizing that concepts with a “positive flavor” have links to multiple processes likely to influence health outcomes including biological processes, such as neuroendocrine and immune function, that may be directly related to disease progression and symptoms [ 27 , 45 – 47 ] and behavioral and social processes, such as preventive behaviors, risk behaviors, social support, appraisals of potential stressors, coping, and attention to health risks [ 48 – 50 ]. For example, optimism predicts multiple forms of preventive health behavior and self-care, including greater exercise, healthier diet, and not smoking [ 32 , 33 , 51 ], whereas fatalism shows consistent prospective and reciprocal associations with multiple serious health-compromising behaviors, such as unsafe sexual activity, suicide attempts, and fight-related injuries [ 52 ]. Optimism and positive affect are also associated with greater perceived social support and more frequent, higher-quality social interactions [ 46 , 53 – 55 ]. Finally, although such effects have received considerably less research attention, positive beliefs and expectations may also promote medical adherence, including participation in rehabilitation efforts [ 56 ]. Indeed, randomized controlled interventions to improve specific illness perceptions among myocardial infarction (MI) patients regarding the timeline, consequences, and control of heart disease (for example, belief that one's heart attack had created irrevocable damage and that one would need to reduce his or her activities significantly over the long-term) have been shown to speed return to work and improve symptoms [ 57 ].

It is important to recognize not only that there are multiple pathways through which positive phenomena may influence health outcomes, but that these pathways may have important reciprocal relations over time. In their examination of psychosocial factors that may influence health among women with breast cancer, Antoni, Carver, and Lechner [ 58 ] cite dispositional optimism, benefit-finding, social support, and anxiety reduction as resilience factors and also construct a model to account for how these variables might affect stress physiology [ 59 , 60 ]. They suggest that such psychosocial variables relate to neuroendocrine and immune system regulation and, in turn, affect tumor growth through stress-induced dysregulation. Accordingly, they suggest that development of more approach-focused coping strategies, anxiety reduction techniques, and social skills training that improves ability to utilize social support could have a salutary effect on immune system functioning. A study of a group intervention that involved teaching these types of strategies to breast cancer patients found reductions in cortisol that were associated with increases in benefit-finding among participants [ 58 ]. Similarly, Epel, McEwen, and Ickovics [ 8 ] reported that women scoring higher on posttraumatic growth, particularly appreciation of life and spiritual change, habituated more quickly to a laboratory-induced stressor as measured by cortisol levels.

As suggested by the above findings, an important development in the study of positive phenomena and health has been the study of positive beliefs and states within the laboratory stress challenge paradigm. While such designs cannot, of course, replicate the experience of managing cancer or other serious illnesses, they do provide precise experimental control of positive phenomena and objective measurement of physiological outcomes. Thus far, such research suggests that both preexisting and experimentally induced forms of positive thinking (self-enhancement and self-affirmation, respectively) have similar salutary effects on stress physiology. Specifically, a laboratory stress challenge paradigm demonstrated that high self-enhancers—people who view themselves in a more positive light than others view them—had lower cardiovascular responses to stress and more rapid recovery, as well as lower baseline cortisol levels [ 61 ]. Self-enhancers appear to have higher self-esteem, optimism, and belief in their ability to master situations, and this, in turn, may lower hypothalamic–pituitary axis activity. Importantly, similar findings have been obtained for experimental manipulations of various forms of self-affirmation among people managing both laboratory [ 62 ] and naturalistic stressors [ 63 ], suggesting that the benefits of self-affirmation may be obtained by people with lower levels of resources. Indeed, the physiological benefits of experimentally induced self-affirmation were strongest in the naturalistic stressor study [ 63 ] among the most psychologically vulnerable participants.

Taken together, results from interventions with cancer patients and experiments in which positive beliefs are induced suggest that adaptive capability on the psychological and physiological levels may be linked and that further scientific investigation of such links may improve our understanding of the multiple pathways involved. For example, such links may occur through appraisal and coping mechanisms whereby those who are more optimistic and more able to find benefit or experience growth are more able to use challenge rather than threat appraisals of adverse events [ 64 , 65 ] and to process their experiences with adverse events using deliberate, reflective rumination mechanisms [ 66 ]. In this way, illness may be transformed from a miserable, frightening event to be endured to one that has meaning [ 67 ]. When this occurs, there may be more of a focus on intrinsic goals [ 68 ], leading to a reduction in anxiety and more positive affect. Both intrinsic goals and positive affect, in turn, have been associated with more robust immune system responses [ 64 ].

The study of such links may be profitably extended to the other important pathways through which positive phenomena may be related to health outcomes, notably better health behaviors and improved social support. Although these pathways may not be as amenable to experimental investigation, as they rely on longer-term patterns of preventive health behavior and the maintenance of close and satisfying social ties, increasing evidence suggests that these key behavioral and social processes may be linked to such positive phenomena as benefit-finding and other efforts to find meaning in adversity. For example, MI and breast cancer patients exhibited different kinds of positive effects of their diseases—the MI patients (mostly men) engaged in healthy lifestyle change and the cancer patients reported increased empathy and improved relationships [ 69 ]. Research is also starting to uncover links between religious or spiritual efforts to find meaning in adversity and important behavioral and social pathways linked to health outcomes. For example, in a small exploratory study of high-risk familial melanoma patients and their family members, finding religious or spiritual meaning in one's familial cancer history and/or melanoma genetic test result predicted greater concurrent adherence to recommended photoprotective behaviors and lower reports of sunburns and tans [ 70 ]. Religious participation has also been linked to greater perceived social support and greater meaning found in loss [ 71 ].

It appears that in order to understand the relationships between positive psychology constructs and positive health outcomes, researchers must be open to exploring a number of pathways of influence on these outcomes. Some pathways may involve profound changes in perspectives on living that will promote changes in health and social behavior that yield better health outcomes. Others may involve changed life perspectives that reduce stress responses and have effects on immune system functioning. Other pathways to better health outcomes might proceed from more specific changes in health or social behavior that yield health benefits, without more general personal transformations. Prospective designs that are sensitive to these various pathways and trajectories and that consider important reciprocal links among changes in health behaviors, social processes, appraisals, coping strategies, and disease-relevant biomarkers will continue to elucidate the ways in which positive phenomena may be related to health outcomes over time.

Continuing process-oriented efforts to understand multiple, interrelated pathways through which positive states—emotions, expectations, appraisals, and other beliefs—may influence health can only improve our science and practice. However, we suggest that progress in understanding these links may be unnecessarily limited by a set of pervasive and likely unwarranted assumptions about the nature and function of positive phenomena in general [ 48 , 72 – 75 ], specifically that positive thoughts and feelings (1) undermine systematic and efficient thinking, especially for negative information; (2) cannot coexist with negative thoughts and feelings; (3) have effects that are symmetrical and opposite to those of negative thoughts and feelings; and (4) are pleasant, but trivial, having few lasting effects. In the following sections, we briefly examine these assumptions and their likely impact on research and practice at the interface of positive psychology and health psychology.

Positive Thoughts and Feelings Undermine Decision-making, Especially for Negative Information

Multiple accounts of the effects of positive mood on judgment suggest that positive beliefs and states decrease the quality of attention to information, in general, and to negative information, in particular, either through mood-congruent processing, motivations to maintain a positive mood, and information that the environment is safe and one can relax vigilance to negative information or through distraction caused by the large and diverse set of associations primed by positive mood (for review, see [ 72 ]). These accounts share the central assumption that positive beliefs and states have an unwavering deleterious main effect on cognitive processes: they make people less systematic and discerning thinkers, especially for negative information, and as a result, they promote risky judgments and behaviors. This assumption has an especially pervasive corollary—that positive beliefs and states promote appraisals of virtually anything as positive, favorable, or likely through mood-congruent processing. Therefore, optimists, for example, should be prone either to ignoring health risks entirely or to appraising them as less serious and less likely.

This assumption persists despite more than three decades of evidence that induced positive affect promotes more careful, systematic, and efficient decision-making. Programmatic research by Isen and her colleagues shows, for example, that induced positive affect, compared to a neutral condition, promotes more thorough and efficient medical decision-making, greater flexibility in judgment, and better management of real versus hypothetical risks [ 75 , 76 ]. Importantly, although positive affect does promote engagement in pleasant activities, such as play and exploration, it does not do so at the expense of concurrent task demands [ 73 , 77 ]. That is, when some other goal is relevant, people in a positive mood readily forgo pleasant activities in order to focus on necessary tasks. Thus, positive affect rarely has an unwavering and deleterious effect on cognitive processes; instead, positive beliefs and states seem to be quite responsive to situations that call for increased scrutiny of personally relevant information, even when such information is negative or unfavorable. Furthermore, positive affect seems to improve the ability to switch set [ 78 ], which may account for many of the findings regarding improved decision-making under conditions of induced positive affect.

The conclusion that positive states promote adaptive responses to new and potentially useful negative information is further supported by two independent lines of research, one examining the relation of dispositionally held or experimentally induced positive beliefs to the processing of health risk information [ 79 – 85 ] and the other examining the effect of induced positive moods on interest in information about one's weaknesses [ 86 – 88 ]. Both lines of work have obtained similar findings: positive beliefs and states predict greater selection of and attention to personally relevant negative information. Notably, these findings are obtained even when selection of the negative information comes at the expense of an opportunity to learn positive or favorable information about the self. Furthermore, none of these studies found that positive beliefs and states resulted in more favorable appraisals of the negative information presented. Instead, when the health risk or personal liability information was described as self-relevant or selected to be self-relevant based on participants' health behaviors, participants appraised the information as negative and devoted attention to acquiring additional information about it in an unbiased and nondefensive manner. Thus, there is little evidence that being happy or optimistic makes people oblivious to important negative information.

Positive and Negative Thoughts and Feelings Cannot Coexist

The next assumption—that positive and negative feelings cannot coexist and, therefore, that people who are experiencing a negative life event or serious illness cannot and should not simultaneously experience positive feelings or expectations—is one that was identified early in the scientific study of psychological responses to such negative life events as bereavement and physical disability [ 89 – 91 ]. This assumption may lead researchers and clinicians to omit measures of positive thoughts and feelings from their questionnaires and interview protocols. It may also influence the interpretation of such thoughts and feelings when they are expressed by patients and their loved ones. Specifically, the expression of positive thoughts and expectations by people facing threats to their own or others' health are often seen not as indications of a person's efforts to find meaning in adversity, but instead as indications that the person is not coming to terms with the gravity of his or her situation [ 46 ]. Thus, according to this view, an important goal should be to disabuse people of such expectations.

This assumption, too, persists in the face of a great deal of counterevidence. It is now well-established that life-threatening illnesses and other negative life events can create both positive and negative thoughts and feelings [ 92 ], that people experiencing severe losses report daily positive affect [ 89 , 90 ], and that there are multiple “normal” trajectories for the experience of negative thoughts and feelings following loss, including patterns in which intense negative feelings either are not experienced or do not persist [ 93 ]. Furthermore, the “failure” to experience intense distress early does not predispose people to experiencing greater distress later. With respect to favorable expectations reported by people managing illness and other forms of adversity, it is now recognized that optimistic beliefs are not only common among people managing life-threatening illnesses, but also frequently associated with better psychological adaptation, better health practices, and better immune function [ 47 ].

These findings suggest that research at the interface of positive psychology and health psychology should focus not only on the presence of positive thoughts and feelings among people managing serious illness, but also on the precise role that such feelings may play in managing both the illness itself and the psychological and social demands it may create. For example, the joint activation of positive and negative thoughts and feelings may allow people to process the negative thoughts and feelings surrounding a severe stressor ([ 94 ]; see also [ 95 ]). In this view, consistent with the ideas noted earlier, the experience of positive thoughts and feelings is central to the effective management of negative thoughts and feelings, not simply a distraction or a nicety. An important implication of this line of reasoning is that interventions that seek to promote positive emotions, expectations, or life changes among people managing serious illness or loss may do more than distract people from their troubles: they may play an important role in the effective management of their situation.

Positive and Negative States are Symmetrical and Opposite in Their Effects

A third assumption that limits research and practice is the assumption that positive and negative states are symmetrical and opposite in their effects; that is, if negative emotions and expectations have one effect (for example, alerting people to danger), then positive emotions and expectations must have the opposite effect (decreasing vigilance to potential dangers). This assumption has been notably disproven in several research areas, including decision-making and attention to risk information, as reviewed earlier, and also helping behavior. In these lines of research, it has been demonstrated that both induced positive and negative states have effects that are distinct from neutral conditions, and that they can have similar effects on judgment and behavior, but for different reasons [ 74 ].

There are several implications of this point for the design of research and intervention. First, many experiments test positive versus negative states without the inclusion of a neutral condition. Such designs preclude a determination of the independent effects of positive and negative states—the effects obtained may be due to changes created by positive states, changes created by negative states, or both. As but one example of the conceptual advances that may result from avoiding assumptions about the symmetrical and opposing effects of positive and negative states, consider King and Miner's extension [ 96 ] of Pennebaker's therapeutic writing paradigm [ 97 ]. Most accounts of the health benefits obtained from therapeutic writing suggest that they derive from emotional catharsis and intense sustained efforts to find meaning from previously undisclosed trauma. However, King and Miner found that participants randomly assigned to write about perceived benefits from a traumatic experience experienced the same lasting decrease in doctor visits over the next several months as participants instructed to write about a traumatic event. That is, both groups obtained benefits, compared to control participants. Interestingly, the essays written by participants instructed to focus on perceived benefits not only included a higher proportion of positive emotion words (as would be expected), but also included a higher proportion of cognitive mechanism words related to insight and causation than essays written in the other conditions, and the use of these insight-related terms predicted fewer health center visits for illness 3 months later. Consistent with the ideas presented earlier, King and Miner suggested that benefit-finding may foster effective self-regulation of the negative emotions caused by the traumatic experience and efforts to find meaning in it.

Second, with respect to studies of coping and mental and physical health outcomes, the need to test whether positive constructs (e.g., positive affect, dispositional optimism) have unique effects over and above—or simply different from—those of related negative constructs (e.g., negative affect, neuroticism, pessimism) remains acute. Progress on this score is being made [ 27 , 44 , 45 , 95 , 98 – 101 ], but more remains to be done to understand the unique health effects of positive thoughts, feelings, and expectations [ 46 ]. This is perhaps where a greater effort to develop laboratory analogs to test induced positive states—for example, Fredrickson and colleagues' work on physiological undoing [ 102 ]—may aid our understanding of their unique effects. However, Pressman and Cohen [ 46 ] caution that positive affect inductions that are particularly activating or engaging may differ from the naturalistic experience of positive emotion not only in duration, but also in intensity and may, therefore, have different physiological effects.

A third implication of this assumption is that the measurement strategies employed in many studies are likely to fail to capture unique aspects of positive thoughts, feelings, and expectations. Many studies, including those said to evaluate the effects of positive thinking on health outcomes, include only measures of negative thoughts, feelings, and outcomes and assume that low scores on such instruments represent the presence of positive thoughts and feelings. It is beyond the scope of this article to discuss the lively debate concerning the separability of positive and negative affect as independent dimensions of experience (for reviews and divergent perspectives on the bipolarity of affect, see [ 103 – 106 ]); however, a simple example may suffice: just as there may be more to be healthy than not being ill, there is likely to be more to being happy or fulfilled than not being depressed or anxious [ 107 ]. An intriguing recent analysis by Ryff and colleagues [ 108 ] examining the relationship between multiple aspects of psychological well-being and ill-being and diverse biomarkers found more evidence consistent with the idea that positive and negative mental health outcomes have distinct associations with neuroendocrine and cardiovascular biomarkers than that such effects are mirror opposites. Accordingly, research designed to evaluate the association of positive thoughts and feelings with subsequent health outcomes should include measures specifically designed to assess the presence of those thoughts and feelings, not just the absence of negative thoughts and feelings, and symmetrical and opposing relations (i.e., bipolarity) should not be assumed. Additionally, researchers and practitioners should be aware of important efforts to conceptualize psychological well-being as more than the presence of positive affect (e.g., dimensions other than happiness [ 109 , 110 ]) and to delineate cultural differences in the kinds of positive emotional experience that people seek (again, dimensions other than happiness [ 111 ]).

Positive States are Trivial Niceties, Incapable of Creating Any Lasting Benefit

The last assumption we wish to discuss follows in part from the first three, namely, that positive thoughts and feelings and, by extension, efforts to promote them are ultimately trivial. In this view, positive feelings are seen as pleasant, but incapable of creating any lasting benefit, especially for people managing serious illness or loss. Accordingly, efforts to promote positive thoughts and feelings not only encourage false hope for benefit, but also may take resources away from the important work of managing negative realities. We suggest that many of the lines of research and intervention that we have highlighted in this article present viable counterpoints to this assumption, but also that much work remains to be done to test these ideas and the potential mechanisms through which positive states may improve health outcomes. To the extent that positive beliefs and states improve immune function and provide other physiological benefits, such as decreased cardiac reactivity; promote social support-seeking and receipt; promote more active forms of coping; improve attention to health risk information and subsequent medical decision-making; and foster better health practices, they may play an important role in the longer-term management of health risks and serious illness [ 47 , 48 , 50 , 112 ]. In these ways, positive beliefs and states may do more than make us feel good in the short-term: they may also build personal and social resources in ways that promote better long-term outcomes [ 54 , 113 , 114 ].

Thus far, we have identified several lines of research with direct implications for human health and well-being and we have identified several pervasive and likely unwarranted assumptions concerning the role of positive thoughts, feelings, and expectations in the management of serious illness and other forms of adversity. At this point, it may be appropriate to directly address some of the obvious dangers of promoting positive thoughts and feelings for either the prevention or management of illness. Perhaps, the principal danger of popular versions of positive psychology, namely, those with a seemingly relentless emphasis on mandating optimism, individual happiness, and personal growth no matter the circumstances, is that the general public may come to believe that one can conquer cancer by thinking positively and that if one is not getting a good response, one is not thinking positively enough, not laughing enough, or not being spiritual enough. Indeed, the explicit blame of people with serious illness for their failure to cure themselves in best-selling popular treatments of positive thinking [ 115 ] is shocking and reprehensible (for discussion, see [ 116 – 118 ]).

With saccharine terrorism Mr. Peale refuses to allow his followers to hear, speak or see any evil. For him real human suffering does not exist; there is no such thing as murderous rage, suicidal despair, cruelty, lust, greed, mass poverty, or illiteracy. All these things he would dismiss as trivial mental processes which will evaporate if thoughts are simply turned into more cheerful channels ([ 120 ], p. 399).

Saccharine terrorism, victim-blaming, and the promotion of mindless versions of positive thinking for personal gain (e.g., The Secret 's “Ask. Believe. Receive.”) are no less problems today, but they are not caused by scientific efforts to understand the neurobiological, cognitive, social, developmental, and structural underpinnings of positive phenomena or to develop interventions to provide potential benefits to those who seek them. Nevertheless, to avoid promoting false hope to patients and their families and contributing to a new generation of “saccharine terrorism,” health psychologists may need to become more proactive in countering exaggerated popular claims based on their own and others' work (see, e.g., [ 121 ]). At the same time, however, we should not prematurely abandon scientific efforts to understand a more complete picture of adaptive functioning that includes elements that promote successful management of illness and, in some cases, restoration of health.

By focusing on concepts such as sense of coherence, meaning, optimism, positive affect, benefit-finding, cognitive adaptation, and growth that have been adopted by the field of health psychology (or, in some cases, have originated in it), we can see ways in which our discipline can become better informed about the role that these constructs play in resistance to illness, managing illness, and healing processes. The use of prospective, process-oriented, and where possible, experimental designs to examine the relation of positive phenomena to multiple health outcomes will be essential to advancing our understanding of these processes. There are initial indications in the work of Antoni and his colleagues [ 58 ] that effective interventions based on these constructs (e.g., benefit-finding, anxiety reduction, and social support) might be designed to improve health and quality of life in seriously ill patients. To the extent that researchers move beyond cross-sectional studies and anecdotal reports of positive outcomes in people with serious illness, continue to demonstrate direct links with mechanisms related to immune system functioning, cardiac reactivity, and other aspects of stress physiology, and broaden their investigations to examine a comprehensive set of potential pathways through which positive phenomena may influence health (e.g., through social behavior, health-promoting and health risk behaviors, coping with adversity, and health-related decision-making), positive phenomena are likely to assume a more prominent role in health psychology.

An important part of such developments will be openness to debate. The efforts of researchers who pose constructive challenges to core assumptions and findings—for example, whether benefit-finding and perceived gains following adversity are real [ 122 , 123 ] and whether there are some circumstances that defy efforts to find meaning or benefit [ 124 ]—advance the field by identifying new explanations and potential limiting conditions [ 125 ]. The same is true in the study of positive thinking in which efforts to identify different forms of positive thinking and to determine which forms promote goal attainment and health and which do not [ 126 – 131 ] similarly advance the field and offer the promise of more effective interventions. Critics who identify some of the potential pitfalls that may occur in the application of research findings, for example, those involving spirituality and health, to medical practice [ 132 ] make an important contribution, as do those who question whether the strength of research evidence for particular interventions warrants their use [ 133 , 134 ]. Finally, researchers who spur debate about whether positive beliefs like optimism have a meaningful and independent conceptual status in their own right as opposed to being the flipside of neuroticism ([ 135 ], but see [ 101 ]), who seek to identify the “active ingredient” in measures linked to health outcomes [ 46 , 136 ], and who question the relation of newly identified concepts, theories, and approaches to existing ones [ 22 , 137 ] raise the conceptual challenges necessary to a cumulative science.

As research at the interface of positive psychology and health proceeds, we believe that researchers and practitioners should avoid contributing to the “tyranny of positive thinking” by rejecting a singular focus on positive outcomes of illness and by actively debunking spurious claims about the curative power of positive beliefs. At the same time, however, researchers and practitioners should also avoid the premature rejection of systematic scientific efforts to elucidate the role of positive thoughts and feelings in human health and to develop interventions to promote those that provide benefit. Much remains to be done to elucidate the specific mechanisms through which different positive phenomena may be related to the etiology and progression of cancer and other diseases and to understand how these processes may operate differently for different diseases, including different forms of cancer. In considering the concept of benefit to health, we suggest that it will be important to recognize that interventions that promote psychological well-being have benefit in their own right, even if they have modest or no demonstrable influence on disease progression. To the extent that our research is designed to assess both positive and negative phenomena, to examine how they may be related over time, to examine multiple pathways through which each may prospectively influence health, and to provide a fair test of positive phenomena by assessing them in their own right, continued research at the interface of health psychology and positive psychology has the potential to illuminate the potential benefits and liabilities of positive phenomena in the etiology, progression, and management of illness.

We thank Allen Sherman and Suzanne Miller for their helpful comments on an earlier version of this article and Angela Newman for her assistance in the preparation of this manuscript.

Aspinwall LG , Staudinger UM . eds. A Psychology of Human Strengths: Fundamental Questions and Future Directions for a Positive Psychology. 2003 ; Washington : APA Books .

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• Research article
• Open access
• Published: 06 August 2021

Mindfulness-based positive psychology interventions: a systematic review

• Joshua George Allen   ORCID: orcid.org/0000-0001-9662-9863 1 ,
• John Romate   ORCID: orcid.org/0000-0003-0487-7849 1 &
• Eslavath Rajkumar   ORCID: orcid.org/0000-0002-3012-0391 1  

BMC Psychology volume  9 , Article number:  116 ( 2021 ) Cite this article

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There are hundreds of mindfulness-based interventions in the form of structured and unstructured therapies, trainings, and meditation programs, mostly utilized in a clinical rather than a well-being perspective. The number of empirical studies on positive potentials of mindfulness is comparatively less, and their known status in academia is ambiguous. Hence, the current paper aimed to review the studies where mindfulness-based interventions had integrated positive psychology variables, in order to produce positive functioning.

Data were obtained from the databases of PubMed, Scopus, and PsycNet and manual search in Google Scholar. From the 3831 articles, irrelevant or inaccessible studies were eliminated, reducing the number of final articles chosen for review to 21. Interventions that contribute to enhancement of eudaimonia, hedonia, and other positive variables are discussed.

Findings include the potential positive qualities of MBIs in producing specific positive outcomes within limited circumstances, and ascendancy of hedonia and other positive variables over eudaimonic enhancement.

In conclusion, exigency of modifications in the existing MBIs to bring about exclusively positive outcomes was identified, and observed the necessity of novel interventions for eudaimonic enhancement and elevation of hedonia in a comprehensive manner.

Peer Review reports

Background of the study

Mindfulness, a practice of conscious non-judgmental awareness to the present, emerged in the Indian subcontinent approximately 2500 years ago [ 1 ]. Around four decades back, with the pioneering works of Kabat Zinn who had incorporated mindfulness into psychotherapy, the scientific application of mindfulness for health and well-being for specific contextual needs had started [ 2 ]. Since then and particularly in the last decade, academic interest in the area of mindfulness has been increasing and the applicability of mindfulness in various facets of life is also getting attention [ 3 , 4 , 5 , 6 , 7 , 8 ]. Most of the accessible Mindfulness-Based Interventions (MBIs) are either standalone therapies or facilitating therapies for various clinical disorders and problems. Although mindfulness contributes immensely to clinical psychology, the concept of mindfulness has a broader and vaster meaning, beyond clinical symptom reduction and toward positive human functioning and flourishing. In recent years, Positive Psychology Interventions (PPIs) that integrate mindfulness elements have shown some promising outcomes [ 1 , 9 , 10 ]. Still, there is a significant lack of clarity in the implementation of Mindfulness-Based Positive Psychology Interventions (MPIs) and their impact on positive human functioning. Hence the current study aims to find and analyze the mindfulness-based interventions from the existing literature which have also shown potentials to be a positive psychology intervention.

Beginning from Mindfulness-Based Stress Reduction (MBSR) proposed by Kabat Zinn in the 1970s, MBIs are mostly used in the clinical settings for managing disorders and supporting prognosis of disorders and diseases. As an attempt to balance this reductionist deficit-model of health, the well-being outcomes of MBIs are also studied, especially in recent years. A positive psychology intervention is defined as “an intervention, therapy, or activity, primarily aimed at increasing positive feelings, positive behaviors, or positive cognitions, as opposed to ameliorating pathology or fixing negative thoughts or maladaptive behavior patterns” [ 12 ]. In this context, an MPI is “a mindfulness-based intervention with the primary aim to enhance positive human functioning”. PPIs not only exert impact on positive variables, but also are effective among clinical populations—as standalone therapies or facilitating interventions—such as the individuals suffering from depression [ 11 , 12 ], affective disorders [ 13 ], generalized anxiety disorder [ 14 ], and eating disorders [ 15 ]. Apart from that, regardless of the nature of population, PPIs have the potential to enhance positive cognition, positive affect, positive behavior, and overall positive functioning and experiences. Integrating positive psychology with mindfulness, or accommodating mindfulness elements in psychotherapy, a number of MBIs are developed, however, the existing literature is insufficient to articulate the quality and quantity of the researches on MPIs. In order to fill this gap, research on the current status of MPIs is warranted.

Furthermore, well-being mainly consists of hedonia and eudaimonia, two highly correlated but distinct forms of well-being, with different characteristics [ 16 , 17 ]. Though they are not mutually exclusive or antagonistic to each other, their nature, intensity, and patterns of expression are singular. This paper attempts to consolidate major mindfulness-based interventions devised for the enhancement of positive functioning beyond clinical symptom reduction, with a given priority to determine the status of MPIs for eudaimonic enhancement. Secondary importance is given to MPIs or MBIs for hedonic well-being and other positive psychology variables such as hope, happiness, resilience, gratitude, flow, compassion, and improved psychological performance. Studies, where a positive psychology variable was just one among three or more dependent variables, were excluded due to their orientation toward the deficit model rather than to positive psychology.

The positive potentials of mindfulness

Eudaimonic enhancement.

Eudaimonia is originally a Greek term that can be translated from a subjective perspective as “happiness”, and from an objective point of view, as “flourishing” [ 18 ]. Broadly, eudaimonia is “the pursuit, manifestation, and/or experience of virtue, personal growth, self-actualization, flourishing, excellence, and meaning” [ 19 ]. The “mindfulness-to-meaning theory” proposed by Garland et al. [ 20 ], advocates that mindfulness broadens the awareness spectrum resulting in cognitive-reappraisal of events to include the positive possibilities of specific instances, that enable the individual to perceive the meaning and purpose of life experiences. The cumulative effects of meaningful positive experiences bring about eudaimonic well-being. And unlike hedonia, eudaimonia will gradually expand on its own without the support of any external agencies, and its possibilities are literally infinite. This nature of eudaimonia is elucidated by the concepts of “eudaimonic staircase” [ 21 ] and the “upside spiral of positive emotions” described in the broaden-and-build theory [ 22 ]. Thus, this review is expected to be a beneficial contribution to the existing scientific knowledge on the role of MBIs in utilizing the eudaimonic-enhancement capability of mindfulness. In addition, recognition of the current utility spectrum of MBIs would support better usage of those MBIs as eudaimonic enhancement tools, or signify the need of further explorations on MBIs for eudaimonic enhancement.

Hedonic enhancement

Hedonia or hedonic well-being shall be defined as “the pursuit and/or experience of pleasure, enjoyment, comfort, and reduced pain” [ 19 ]. Since pain reduction is an element of hedonia, all kinds of psychotherapies are, in a sense, involved in the augmentation of hedonic well-being. Along with eudaimonia, hedonia contributes to subjective well-being [ 18 ]. The efficacy of MBIs is associated with fulfillment of hedonic needs. Some studies have explored the relationship between mindfulness and hedonic well-being and confirmed the assumption that mindfulness functions in direct and indirect ways to induce pleasure and reduce pain [ 23 , 24 ]. Other than clinical symptom management, hedonia and its components can be induced by MBIs, independently as well as in combination with other positive variables. Enhancement of enjoyment [ 25 ], happiness [ 26 ], and positive affect [ 27 , 28 ] are a few examples. Although not always directly stated, improved hedonia—reduced pain and discomfort or improved pleasure and comfort—had been described in clinical literature where MBIs are utilized for therapeutic purpose. The existing literature recognizes the hedonic enhancement quality of mindfulness, but they are not being studied comprehensively. Hence, this review gives auxiliary importance to narrate the MBIs that produced hedonic well-being.

Increasing other positive outcomes

Theoretically and empirically, mindfulness is found to be connected with a number of positive psychology variables. Different MBIs often focus on a specific aspect such as compassion, relaxation, and cognitive skills. Literature suggests that MBIs are effectual in generating a number of positive outcomes such as hope [ 29 ], optimism [ 30 , 31 ], prosocial behavior [ 32 ], flow [ 33 ] working memory [ 34 ], and academic performance [ 35 ]. This paper also reviews MBIs that had produced positive outcomes in addition to eudaimonic and hedonic well-being, in expectation of identifying the extent of impact conceivable for an MPI.

Purpose of the study

This paper attempts to present a narrative/descriptive synthesis of the major MBIs with positive potentials. Firstly, it intends to identify standardized or empirically validated MPIs. Secondly, MBIs that produce positive functioning shall be recognized and their efficacy as an MPI will be verified. Further, the MBIs that improve hedonic well-being and/or other positive variables will also be reported. Finally, the study stands to recount the intention of MBIs in eudaimonic enhancement.

Data were drawn from three electronic databases—PubMed, Scopus, and PsycNet—and a manual search in Google Scholar, from the inception to 29 May 2020. Keyword string used for database search was “mindfulness intervention” and filters were “controlled clinical trials” and “randomized controlled trial” in PubMed; “articles” and “psychology” in Scopus; and “articles” in PsycNet.

Eligibility criteria

The inclusion criteria were: (i) studies with the application of mindfulness-based intervention regardless of the population characteristics such as age, gender, and ethnicity; (ii) experimental and quasi-experimental studies that compared the outcomes between individuals administered with and without an MBI; and (iii) studies with positive psychology variables as dependent variables. The exclusion criteria followed to eliminate the articles were: (i) review papers, (ii) medical/ neuropsychological researches, and (iii) studies with positive psychology variables as just one among three or more dependent variables.

Positive psychology outcomes considered included but not limited to general well-being, eudaimonic well-being, hedonic well-being, happiness, hope, grit, loving kindness, gratitude, empathy, and flourishing. Studies where positive psychology variable was just one among the three or more dependent variables were excluded. It was because the focus of the current research was to find the MBIs that produced positive psychology variables as outcomes (or positive outcomes); and due to the dichotomous nature of many psychological variables, they have a positive and negative continuum which can be reported as the presence or absence of either positive or negative end. If three or more dependent variables are assessing clinical or non-positive conditions, it is highly likely that the one positive variable among these is the absence of a clinical condition rather than a positive psychology outcome. For instance, well-being is often reported as the absence of a clinical condition such as anxiety or depression. Also, when majority of the outcome measures are related to non-positive variables, the intervention is less likely to be developed for positive impacts. Including such studies would redirect the focus of the study and unnecessarily increase the time, energy, and resources for conducting the research.

Review papers were excluded because the study focused on original researches that reported outcomes of an MBI. Papers on medical/ neuropsychological researches were also excluded because their focus was not identification of positive psychology variables as the outcome measures of MBIs. Rather than the physiological mechanisms behind exposure to an MBI, the current study focused on perceived enhancement of positive psychology variables.

Data collection

A complete database search on PubMed, Scopus, and PsycNet was carried out along with a manual search in Google Scholar (see Fig.  1 ). From the four electronic databases, 5045 articles were found, whose titles and abstracts were transferred to the reference management software Zotero on 29 May 2020. After elimination of duplicates, 3377 articles remained. The first author had screened the articles and removed 3234 articles that did not meet the inclusion criteria, leaving 143 articles for full-text review. In the list of 143 articles two articles were rejected due to unavailability of full-text. Rest of the 141 articles were scrutinized and 120 articles were removed that met the exclusion criteria—being review/meta-analytic papers, medical/ neuropsychological researches, or studies where positive psychology variables were just one among three or more dependent variables. At the first stage of elimination, the third author had verified 30% of the randomly chosen articles, and at the second stage of elimination the second and third authors had randomly chosen 30% of the full-text articles and cross-verified, after which 100% of consensus was confirmed regarding the exclusion and inclusion of the articles. Finally, 21 articles that reported an MBI with an anticipated impact on positive variables were chosen for the review. Risk of bias tool of Cochrane (2019 version) [ 36 ] was used to identify risk of bias of the finally chosen articles. In order to reduce any bias during the process of quality assurance, all of the authors had independently applied the tool among all the chosen studies. Except minor differences of opinion, which were resolved through references to literature and open discussions, no major conflicts had occurred. Studies were found to have low risk or some concerns, and none of the chosen studies had shown high risk.

PRISMA flow diagram [ 65 ]

Among the 21 articles analyzed, 22 studies were identified, out of which two studies consisted of clinical populations and 20 different normal populations. Collectively, these 22 studies had assessed the impact of the intervention on 134 dependent variables, and 105 of these were positive aspects (eudaimonia and related aspects = 65, hedonia and related variables = 8, general well-being = 7, other positive psychology variables = 25). The finally chosen studies showed a high heterogeneity in terms of research designs, types of intervention, and outcome measures, due to which a narrative/ descriptive synthesis of the data was employed. Table 1 shows the list of studies as indicated by the author name(s) and year of publication, subsequent research designs, sample size, intervention, dependent variables, duration of the intervention, the population to whom the intervention was administered, and the major findings related to the intervention. As per the aim of this review, scope of data analysis is limited to identification of interventions as MPIs or MBIs with expected impact on positive variables. The paper describes the results of the studies as it is reported by the authors. There is scope for further studies to verify the efficacy of the interventions and whether they would produce the positive outcomes they intended to generate or capable of generating.

Interventions and procedures

A brief account of the interventions, research design, and procedures are described in this section. Studies are categorized based on the nature of the interventions, aiming to convey better meaning of the elaborate narration. This section aims to identify the MBIs that have the potential to be an MPI. And the next section, ‘Outcomes of MBIs’, deals with categorizing studies based on the intention of the intervention to enhance eudaimonia or hedonia and other positive variables. Here, depending on the nature of the intervention, they are categorized into eight: (1) Psychotherapies, (2) MBIs for children, (3) Mindfulness apps (4) Positive Relationships, (5) Mindful Self Compassion, (6) Loving Kindness Meditation, (7) MBIs that may act as MPIs and (8) MPIs.

Psychotherapies

MBIs are commonly used as therapeutic strategies, even when the positive outcomes are being explored. In such a study, Nyklícek & Kuijpers [ 28 ] had applied the MBSR intervention among distressed adults using a randomized waitlist controlled trial. The study intended to find out if the effect of MBSR on stress, vital exhaustion, positive affect, negative affect, quality of life, mindfulness, and daily mindfulness were mediated by mindfulness. Another research carried out by Amutio et al. [ 37 ] attempted to estimate the effect of MBSR on mindfulness and relaxation states of 42 physicians. The primary aim of the study was to test the efficacy of MBSR in inducing relaxation among professionals from a highly distressing career background. Also, heart rate was included as a dependent variable in order to confirm that MBSR could act as a relaxation method at a physical level as well. Although relaxation is a byproduct of mindfulness, other possible positive outcomes that could have opened ways to enhance human well-being and flourishing, were not the object of focus in this study. In another study, de Vibe et al. [ 38 ] had reported a six-year-long longitudinal study, where the impact of a seven-week abridged MBSR is described. The study illustrates the well-being, coping, and mindfulness of 288 participants. Another popular psychotherapy that makes use of mindfulness is Acceptance and Commitment Therapy (ACT). A guided seven-week internet-delivered Acceptance and Commitment Therapy (iACT) was administered among 68 university students with high distress. The participants’ well-being (psychological, emotional, and social domains), life satisfaction, self-esteem, mindfulness, stress, anxiety, depression, psychological flexibility, and sense of coherence were assessed by eight psychological assessment tools [ 39 ]. Since the study had combined clinical and positive outcome measures and because the interaction among these variables was uncertain, it is safe to refrain from concluding that iACT would be useful as a positive psychology intervention. Mostly, the MBIs with psychotherapeutic properties are predominantly governed by deficit-reduction qualities and the positive outcomes are only consequential.

MBIs for children

Three of the reviewed studies had been conducted among children [ 32 , 40 , 41 ]. Eudaimonic well-being among children is an area in the scientific literature with extremely less empirical information [ 42 ]. And the operational definitions of eudaimonia assessed among children are found to be limited in scope. In a study that attempted to see the impact of an MBI among child population, Huppert & Johnson [ 41 ] had administered four 40 minutes of mindfulness classes, one session per week, to 155 boys belonging to the age group of fourteen and fifteen years. Pre and post-assessments were conducted on their mindfulness, resilience, well-being, and big-five personality variables. In another research, Flook et al. [ 32 ] had observed 68 preschool children who were administered with a 12-week Mindfulness-Based Kindness Curriculum. A randomized waitlist controlled design was employed to obtain the amount of their social competence (a combination of pro-social behavior and emotion regulation), sharing, delay of gratification, cognitive flexibility, inhibitory control, and academic performance. Devcich et al. [ 40 ] had carried out another study where a novel intervention namely “Pause, Breathe, Smile” was tested for its efficacy with an active-controlled pilot design, against an emotional literacy program. Duration for both of the programs was one-hour weekly sessions for eight weeks. The study assessed pre and post scores of 91 school children, on well-being—including hedonia and eudaimonia—and mindfulness. Considering that the target population is children, it is not to be expected to find a concept as complex as eudaimonia to be manipulated or measured effectively, particularly when the interventions do not follow a standardized procedure. Although mindfulness was taught, the studies did not primarily focus on the well-being or other positive functioning of the participants, possibly because of the difficulty in gathering information on positive experiences from children. Hence, the three different interventions adopted here cannot be considered as effective tools for enhancing well-being and flourishing, but they shall be useful tools for specific targeted behavioral modifications and academic performance.

Mindfulness apps

The use of online platforms for counselling and psychotherapy is becoming popular nowadays, especially since the outbreak of covid 19 pandemic in 2020 [ 43 , 44 ]. Not just the reduction of undesirable states of mind, but the enhancement of positive functioning is also getting wide acceptance at a global level [ 45 ]. There are a few commercial mindfulness-based applications accessible though smart phones that were also empirically validated through scientific researches. In this review of MBIs, two of the studies chosen had implemented two apps—“Calm” and “Headspace” to explore its impact on health and well-being. Bhayee et al. [ 46 ] had tested the therapeutic efficacy of a commercial neurofeedback assisted, technology-supported mindfulness training (NtsMT). The experimental group was exposed to the “Calm” app in a pre-planned manner with recorded instructions. They have used a randomized active-control trial among 26 participants. Electroencephalogram (EEG) was used as the neurofeedback mechanism, and the psychological variables assessed were attention and well-being. Champion et al. [ 47 ] had conducted another research using a self-guided mindfulness meditation app, “Headspace”. The introductory program of the Headspace, “Foundation 1 to 3” with 30 sessions (10 at each level), was administered to the participants. The minimum duration of a session was 10 min, and there was an option to increase the duration up to 15 and 20 min for second and third levels respectively. They have assessed the life satisfaction, stress, resilience, social impairment, depression, anxiety, hypochondriasis, and enjoyment and experience of 62 participants. Both of these studies had apparently anticipated reduced clinical symptoms from the interventions, and the range of positive outcomes assessed were too narrow, suggesting that the intended use of these apps, in the concerned studies, was not primarily positive functioning.

Positive relationships

Positive relationships is a component of eudaimonic well-being. Three studies selected for the review had utilized three different interventions with the principal aim of improving relationships. Carson et al. [ 48 ] had tested the effect of a novel intervention, Mindfulness-Based Relationship Enhancement (MBRE), on relationship satisfaction, relatedness, autonomy, interpersonal closeness, partner acceptance, relationship distress, spirituality, individual relaxation, and psychological distress. They had adopted a randomized waitlist controlled design and the participants were 44 relatively happy and non-distressed couples. Another MBI that aimed at improving ‘positive relationship’ was applied in a study by Coatsworth et al. [ 49 ]. They had tested the efficacy of the Mindfulness-Enhanced Strengthening Families Program (MSFP) against a standard of care condition and control groups. They have adopted a randomized controlled comparative effectiveness study design with 432 families. The intervention intended to impact interpersonal mindfulness in parenting, parent-youth relationship, youth behavior management, and parent well-being. MSFP was an adapted intervention meant to be a preventive measure to protect adolescents from substance use and behavior problems. With the added element of mindfulness in the adapted version of the intervention, some positive outcomes were also anticipated which were included as dependent variables. Kappen et al. [ 50 ] had conducted another study on positive relationship , using a brief 12-day online mindfulness program. Intended outcomes of this intervention were elevated relationship satisfaction, partner acceptance, and trait mindfulness. Adults who had been in a romantic relationship for at least one year were recruited through social networking sites. Despite being context-specific and not focusing on relationship enhancement in an exhaustive way, these interventions definitely throw some light on the status of MBIs that are considered to be relationship enhancers. Specifically, MBRE, MSFP, and the 12-day online mindfulness program are apparently effective to improve quality of relationships at specific contexts. Since these interventions are designed for healthier relationship between specific target populations, such as couples, the same interventions will not be sufficient to improve relationship quality in another situation.

Mindful self compassion (MSC)

MSC, an intervention developed by Neff and Germer [ 51 ], intends to build self compassion in both normal and clinical populations. It is fundamentally a mindfulness-based positive psychology intervention, which gives priority to self-compassion and secondary importance to mindfulness. Other outcomes resultant from compassion and mindfulness shall also be expected from MSC, but its focus is not shared with any further components of well-being or other positive psychology variables. The current review found two papers where three studies that employed MSC were reported. Neff & Germer [ 51 ] had performed a pilot study and another randomized waitlist controlled trial to examine the effect of the Mindful Self Compassion (MSC) program. The intervention was for eight weeks, one two-hour session per week. They have studied the impact of the intervention on self-compassion, mindfulness, connectedness, happiness, life satisfaction, depression, anxiety, and stress in the first study and have added two more dependent variables in the second study, which are avoidance, and compassion for others. In another study, Yela et al. [ 52 ] had explored the impact of a Mindful Self-Compassion (MSC) program on self-compassion, mindfulness, psychological well-being, anxiety, and depression among 61 psychology trainees. The intervention lasted for eight weeks, with a 2.5-hour session weekly. The MSC interventions applied in these three studies have acted as psychological tools to improve specific elements of eudaimonic and hedonic well-being, along with other factors. The positive impacts of the interventions were looked upon from the point of view of ‘improved well-being through improved mental health’ rather than enhancement of well-being, happiness, flourishing, or meaning in life. It is difficult to conclude whether MSC was effectively established as an MPI through the aforementioned studies, considering the nature of MPI as an intervention with primary focus on positive outcomes. Nevertheless, the study results indeed emphasize the positive potentials of MSC.

Loving kindness meditation (LKM)

LKM is a kind of Buddhist meditation that intends to induce “a feeling of warmth and caring for self and others” [ 53 ]. Among the 22 studies reviewed, two studies had incorporated interventions that utilized LKM. Fredrickson et al. [ 53 ], in their study, recruited 139 working adults into experimental and waitlist control groups and the former was administered with 13 measures that assessed 15 variables—mindfulness, agency thinking, pathway thinking, savoring beliefs, optimism, ego resilience, psychological well-being, dyadic adjustment, positive relations, illness symptoms, sleep quality, satisfaction with life, depression, differential emotions, and emotion experiences. LKM was provided to the former group that extended for seven weeks with one hour weekly sessions. In a different study, Sorensen et al. [ 54 ] had investigated the effects of a novel intervention called ‘Convergence’ that combined LKM and classic guitar music. The two active-controlled conditions were given either music alone or meditation alone. All three conditions were prolonged for three weeks, providing one session per week, and the participants were assessed for mindfulness, self-compassion, fears of compassion, stress and anxiety, and mental well-being. Both of these researches focused less on the positive qualities of the intervention. LKM is a meditation practice that involves mindfulness elements but with an additional intentional focus on warm and tender feelings toward oneself and the others. LKM strives to instill an attitude of loving-kindness and do not attempts to enhance any other psychological properties directly. But the study results indicate that it is sufficient to improve specific aspects of hedonic and eudaimonic well-being.

MBIs that may act as MPIs

Positive psychology is relatively young and the number of studies is not yet comparable with that of clinical psychology and other deficit-focused fields of psychology. But it is a rapidly developing area that overlaps with the studies on mindfulness. There were three researches in this review where the positive psychological variables were looked into more vigorously. One of these was reported by Rodríguez-Carvajal et al. [ 55 ] where a non-randomized controlled study was used among 73 participants to substantiate the effect of a three-week Mindfulness Integrative Model (MIM) on mindfulness, self-compassion, and positive states of mind. In another instance, Pogrebtsova et al. [ 56 ] had studied the impact of a five-day combined mindful-reappraisal intervention on students’ positive and negative experiences, positive re-appraisal, decentering, curiosity, and optimism. The sample consisted of 106 participants where 36 were in the experimental group, which was compared against a ‘standard of care’ condition and active control group. The third study was carried out by Vich et al. [ 57 ] where a modified intervention, ‘Relational Mindfulness Training’ (RMT) was administered to 75 management students, and their self-compassion, compassion, stress, mindfulness, and happiness were measured. Despite a larger part of well-being aspects being still unexplored, the positive potentials of MBIs are well-documented in these researches. Further studies shall unravel the actual positive qualities of these interventions.

Mindfulness-based positive psychology interventions (MPIs)

It sounds as if two studies had explored the exponential positive power of MBIs. Ivtzan et al. [ 58 ] had studied the impact of a novel MPI, eight-week online ‘Positive Mindfulness Program’ (PMP) on eudaimonic and hedonic well-being, stress, depression, mindfulness, gratitude, self-compassion, autonomy component of psychological well-being scale, self-efficacy, meaning in life, compassion for others, and appreciation for the present moment, among 168 adults from 20 different countries. They have used a randomized waitlist controlled trial with pre, post, and one-month follow up data. Here, PMP had tested both clinical and positive outcomes, but basically it is an intervention developed to improve well-being through nine specific components –(i) positive emotions, (ii) self-compassion, (iii) well-being (happiness), (iv) autonomy, (v) mindfulness, (vi) self-efficacy (strengths), (vii) meaning, (viii) compassion, and (ix) engagement (savoring)’ [ 1 ]. In a different study by Smith et al. [ 59 ], 31 meditating adults were assessed for quality of life, subjective well-being, well-being, valuing, psychological flexibility, mindfulness, and cognitive fusion. The experimental group consisted of 17 individuals who had practiced Dharma in Daily Life (DIDL) for 30 minutes per day, extending six days a week, for two years course period and six months follow-up period, and possibly beyond. DIDL indeed had undeniable positive impact, but the intensity and duration raises questions about its feasibility as a common MPI. Nevertheless, both PMP and DIDL show promising utility of MPIs for enhancement of eudaimonia, hedonia, and other specific positive variables.

Outcomes of MBIs

The reviewed studies vary greatly based on research designs, outcome measures, intensity and structure of interventions, and analytical methods adopted. Hence, due to this high heterogeneity, it was only possible to narrate a peripheral report of outcomes. Depending on the effect sizes of outcome measures, there is an extended scope for further studies which surpass the objectives of the current review. Here, based on the intended positive outcomes of the interventions, studies are categorized into: (1) Enhancement of eudaimonia, (2) Enhancement of hedonia, and (3) Enhancement of other positive variables.

Enhancement of eudaimonia

In a randomized controlled efficacy trial, Rasanen et al. [ 39 ] found that there is a significant increase in well-being, life satisfaction, and mindfulness among the participants who had exposed to the iACT. They had also reported less stress and depression. These effects were intact in a 12-month follow-up as well. The study results show the plausible impact of an MBI on well-being, life satisfaction, and mindfulness, that shall contribute to a sense of purposeful living, one of the different components of eudaimonia.

Devcich et al. [ 40 ] had administered a mindfulness-based intervention, ‘Pause, Breathe, Smile’, to 45 school children as part of a research. Compared to an active control group, the former children had shown higher mindfulness and well-being (hedonia, eudaimonia, and socially desirable responsibility). The MBI ‘Pause, Breathe, Smile’ is likely to contribute to the eudaimonic well-being of children, not in a comprehensive way but to a limited extent.

Carson et al. [ 48 ] had observed the significant positive impact of Mindfulness-Based Relationship Enhancement on relationship functioning and well-being of couples, even when the couples were relatively happy and non-distressed at the baseline level. They had received results that supported the beneficial effect of the MBI on all dependent variables that was maintained at a three-month follow-up. In their study, Coatsworth et al. [ 49 ] had applied MSFP for strengthening four conditions related to family functioning. They have concluded that MSFP improved interpersonal mindfulness in parenting, parent-youth relationships, youth behavior management, and parent well-being. Kappen et al. [ 50 ] reported that, after a 12-day online mindfulness practice, 56 participants with lower baseline mindfulness reported higher relationship satisfaction and partner acceptance compared to the control group. Otherwise, both the groups, regardless of the administration of mindfulness practice or psycho-education, showed no significant difference in the aforementioned variables. In these studies, three different interventions indicate the possible usage of MBIs for ‘positive relationships’, a component of eudaimonic well-being.

Yela et al. [ 52 ] had studied the effects of MSC program and found that it has a significant impact on self-compassion, mindfulness, and psychological well-being (PWB) or eudaimonia. Despite focusing on the enhancement of compassion alone, the intervention proved to be a potential MPI for eudaimonic enhancement.

Ivtzan et al. [ 58 ] had tested the impact of PMP, on 11 psychological variables. The result indicated that there was a significant difference between the experimental and control groups on the basis of their scores of all the 11 dependent variables, including eudaimonic and hedonic well-being, mindfulness, meaning in life, compassion, and gratitude. PMP focuses on enhancement of both hedonic and eudaimonic well-being and accounts promising outcomes as an MPI for eudaimonic enhancement.

Enhancement of hedonia

In a field experimental study, Fredrickson et al. [ 53 ] found that the practice of LKM improved participants’ positive emotions (amusement, awe, contentment, joy, gratitude, hope, interest, love, and pride, collectively), and its effect expanded beyond the duration of meditation and cumulated overtime. Pogrebtsova et al. [ 56 ] had administered a five-day mindful reappraisal intervention to 36 participants and acquired results that suggest a decrease in negative affect and increase in positive affect toward the end of the intervention, compared to the scores of an active control and a standard of care conditions. Smith et al. [ 59 ] elucidated an instance when 17 participants were studied against a control group of 14 after getting exposed to DIDL intervention. It was stated that the experimental group, post-intervention, reported higher subjective well-being, well-being, mindfulness, psychological flexibility, and valuing. Nyklicek & Kuijpers [ 28 ] had narrated the impact of MBSR on stress, vital exhaustion, positive affect, quality of life, and mindfulness, in a randomized controlled trial. Compared to the control group, individuals exposed to the MBSR reported decreased stress and vital exhaustion, and increased positive affect, quality of life, and mindfulness. In a study using MIM, Rodriguez-Carvajal et al. [ 55 ] had found that the intervention enhanced mindfulness, self-compassion, and positive mental states.

The interventions mentioned above are valuable in improving specific aspects of hedonic well-being—either by reducing negative experiences or by improving pleasure and joy.

Enhancement of other positive variables

Flook et al. [ 32 ] had obtained evidence for a 12-week mindfulness-based Kindness Curriculum being effective in improving social competence, including pro-social behavior and emotion regulation, of pre-school children. It had also improved academic performance, tendency to delay gratification, and cognitive flexibility. In a longitudinal study, de Vibe et al. [ 38 ] reported that after a six-year follow-up, the participants who had undergone a 7-week abridged MBSR scored higher in well-being, mindfulness, and problem-focused coping that was a predictor of higher well-being. They had also revealed deteriorated avoidance-focused coping. The results were present even among the participants with low adherence to the regular practice of MBSR. Amutio et al. [ 37 ] have also described the effect of MBSR on well-being and related variables. At the end of the intervention period, participants in the experimental group scored significantly higher in mindfulness and relaxation. After a 10-month maintenance phase, their already reported positive outcomes were found to have increased even higher, particularly the scores on mindfulness, and all four dimensions of relaxation state—mindfulness, positive energy, transcendence, and relaxation. Bhayee et al. [ 46 ], using the app 'Calm', had studied the impact of an NtsMT on attention and well-being. The result suggested a moderate effect of mindfulness on attention and well-being while previous literature had a different say on its effect size. The reason shall be attributed to the delivery mode of the intervention, its duration, or both. Sorensen et al. [ 54 ] had introduced a novel intervention, Convergence , that was tested for its efficacy in comparison with an LKM-only group and a music-only group. The results indicated that all these three conditions improved mindfulness, self compassion, and well-being with small effect sizes. A study conducted by Huppert & Johnson [ 41 ] revealed high positive association between the time spent for mindfulness practice outside the intervention period and the amount of mindfulness and well-being. Other than that, between control and experimental groups, no significant differences were observed. The effect of RMT on compassion, stress, and mindfulness were assessed by Vich et al. [ 57 ]. Their study results outlined that RMT has a significant impact on self-compassion, stress, and mindfulness in the long run. RMT had an impact on compassion, and subjective happiness for a short time, but failed to sustain it over time. In a pilot randomized controlled trial, Champion et al. [ 47 ] had received the effect of the use of a mindfulness meditation app ‘Headspace’ on life satisfaction, stress, and resilience. Highest improvement was on 10 th session, that dropped moderately by the last and 30th session. Through two subsequent studies, Neff & Germer [ 51 ] obtained evidences for the impact of MSC on enhanced mindfulness, self-compassion and well-being.

MBIs as mindfulness-based positive psychology interventions (MPIs)

In the current systematic review, 21 papers were reviewed that described 22 studies on the impact of MBIs over positive human functioning, with prime importance given to eudaimonic well-being and secondary preference given to hedonic and other positive psychology variables. The latter was given secondary focus as hedonic well-being or the tendency to seek pleasure and avoid pain is mostly associated with clinical symptom reduction and temporary pleasurable experiences, rather than well-being and flourishing. Most of the MBIs reviewed were developed for specific needs not comprehensively focusing on either eudaimonia or hedonia and other positive psychology variables. Interventions administered among children were reported by three studies [ 32 , 40 , 41 ] and all these three have focused on a few specific positive psychology variables which cannot be attributed to an overall enhancement in eudaimonic or hedonic well-being. Three studies [ 48 , 49 , 50 ] have focused on a dimension of eudaimonic well-being—positive relationships. One of these is an adapted preventive intervention for adolescent substance use and problem behavior, and could not be considered as an MPI. The target population for six studies was college/university students [ 38 , 39 , 47 , 52 , 56 , 57 ]. One of these has chosen only distressed students and none of the studies focused entirely on well-being. Ten studies had recruited the general adult population through online or regular modes. Some studies advertised for volunteers as participants and some have recruited participants from institutions under different conditions. Most of the studies offered remunerations at various points. None of these studies employed interventions for enhancement of well-being with prime importance, and the positive impact of all of these MBIs was limited, focusing on specific aspects like self-compassion, mindfulness, or resilience. Hence, without ignoring the positive potential of these MBIs, it is required to point out the need for exploring positive outcomes of MBIs more extensively, and modify the existing interventions if required, to incorporate facilities to enhance positive outcomes.

Limitations

The review was restricted to three databases and manual search, and the possibility of unintentional exclusion of relevant articles indexed in other databases cannot be ignored. It is also possible that some of the excluded articles that primarily focus on clinical variables had reported the positive potentials of those clinical interventions. Though not high, there is a risk of bias in the cumulative result. And high heterogeneity of reviewed studies restricted the current research to opt for a systematic review rather than meta-analysis.

Conclusions

The current review has identified the major studies where MBIs were applied and its impact on positive human functioning assessed. The nature, pattern, duration, and focal area of interventions varied greatly and mostly centered around a few specific positive variables rather than overall well-being and flourishing. Application of MBIs for hedonic and other positive variables is found to be more frequent than the usage of MBIs for eudaimonic enhancement. This was not concluded from just the review of the final 21 articles, but from the entire process of finalizing those studies. This is consistent with the statement of Deci & Ryan [ 60 ] who had noted that the number of studies on hedonia greatly exceeds than that on eudaimonia. Hedonic well-being was closely associated with clinical symptom reduction instead of increment in the experience of perceived pleasure. Most of the MBIs applied with expected positive outcomes were context-specific or limited in the scope of applicability. The review was futile in finding any singularly positive-psychology oriented interventions, but a few of the interventions show powerful utility as an MBI that could enhance specific positive variables. Further empirical explorations shall reveal the potency of these MBIs as mindfulness-based positive psychology interventions. Modifications in the structure and functions to be more inclusive of contexts and populations would yield better positive outcomes of the existing MBIs. Also, MBIs that aimed at catering the needs of the recipients based on factors such as culture, ethnicity, and gender would result in highly effective MPIs. From the review, it could also be concluded that it is imperative to develop interventions with sole focus on enhancement of positive potentials, especially eudaimonic enhancement.

Study results point out that physical pleasures derived out of hedonia are not sufficient for the experience of well-being [ 61 , 62 , 63 ]. Keyes & Annas [ 64 ] pointed out the gulf between individuals with high hedonic well-being (48.5%) and their flourishing (18%). This explains the severe eudaimonic deficiency that contributes to the lack of flourishing. And in some other personal or social situations where hedonia can contribute little to a person’s well-being—such as chronic illnesses, physical or psychological pain, financial insecurity, childlessness, bereavement, or social/political unrest—eudaimonia is inevitable to maintain general well-being, happiness, contentment, and a sense of meaning and purpose in life. Eudaimonia apparently buffers against possible psychological harm also [ 64 ]. Hence it demands explorations in the direction of eudaimonic enhancement across different populations, cultures, and contexts. Unfortunately, few researches have addressed this issue so far and eudaimonic enhancement still remains a neglected area within applied positive psychology. Considering the paucity of MPIs exclusively for eudaimonic enhancement, it is recommended that immediate further actions are essential to develop, validate, and avail the same, among both clinical and non-clinical populations. In conclusion, the current study has reviewed the major studies where the MBIs are used for enhancement of eudaimonia, hedonia, and other positive psychology variables. It contributes to the existing scientific literature by pointing out the positive potentials of MBIs and the endless possibilities of empirical studies on the application of MPIs. Finally, the review emphasizes the need of future studies paying attention to the utilization of eudaimonic enhancement potential of MPIs along with the focus on enhancement of hedonic and other positive outcomes.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Mindfulness-Based Intervention

Positive Psychology Intervention

Mindfulness-Based Positive Psychology Intervention

Mindfulness Based Stress Reduction

Internet-delivered Acceptance and Commitment Therapy

Neurofeedback assisted technology supported mindfulness training

Electroencephalogram

Mindfulness-Based Relationship Enhancement

Mindfulness-Enhanced Strengthening Families Program

Mindful Self Compassion

Loving Kindness Meditation

Mindfulness Integrative Model

Relational Mindfulness Training

Positive Mindfulness Program

Dharma in Daily Life

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Allen, J.G., Romate, J. & Rajkumar, E. Mindfulness-based positive psychology interventions: a systematic review. BMC Psychol 9 , 116 (2021). https://doi.org/10.1186/s40359-021-00618-2

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Selected Scholarly Articles

Theoretical Foundations of Positive Psychology:

Positive Psychology: An Introduction , Seligman & Csikszentmihalyi, 2000

APA President’s Address, Seligman, 1998

American Psychologist: Special Issue on Positive Psychology, 2000

Positive Psychology FAQs , Seligman & Pawelski, 2003

A Balanced Psychology and a Full Life, Seligman , Parks, & Steen, 2004

What (and Why) is Positive Psychology?, Gable and Haidt, 2005

Dynamic Spread of Happiness in a Large Social Network: Longitudinal Analysis over 20 Years in the Framingham Heart Study , Fowler & Christakis, 2008

Happiness Can Spread Among People Like a Contagion, Study Indicates , Washington Post, 2008

Non Zero: The Logic of Human Destiny , Robert Wright, 2001

Ordinary Magic: Resilience Processes in Development , Masten, 2001

The Better Angels of Our Nature , Pinker 2011

Enlightenment Now: The Case for Reason, Science, Humanism, and Progress , Pinker, 2018

PERMA and the Building Blocks of Well-Being, Seligman, 2018

Positive Psychology: A Personal History , Seligman, 2019

Agency in Greco Roman Philosophy , Seligman, 2020

Agency in Ancient China , Zhao, Seligman et al., 2021

Psychological History and Predicting the Future , Seligman, 2022

Well-Being Research:

Beyond Money , Diener and Seligman, 2004

Subjective Well-Being: Three Decades of Progress , Diener at al., 1999

Subjective Well-Being: The Science of Happiness and a Proposal for a National Index , Diener, 2000

Using Well Being for Public Policy: Theory, Measurement, and Recommendations , Adler and Seligman, 2016

If, Why, and When Subjective Well-Being Influences Health, and Future Needed Research, Diener, Pressman, and Delgadillo-Chase, 2017

Social Media and Well-Being Research :

Limiting Social Media Decreases Loneliness and Depression , Hunt, Marx, Lipson, & Young, 2018

Detecting Depression and Mental Illness on Social Media: An Integrative Review , Guntuku et al., 2017

Predicting Individual Well-Being Through the Language of Social Media , Schwartz et al., 2016

Gaining Insights from Social Media Language: Methodologies and Challenges , Kern et al., 2016

Psychological Language on Twitter Predicts County-Level Heart Disease Mortality , Eichstaedt et al., 2015

Personality, Gender, and Age in the Language of Social Media: The Open-Vocabulary Approach , Schwartz et al., 2013

Optimism Research :

Association between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers, Hassett et al, 2019

Optimism and Physical Health: A Meta-analytic Review , Rasmussen, Scheier & Greenhouse, 2009

Pessimistic Explanatory Style Is a Risk Factor for Physical Illness: A Thirty-Five-Year Longitudinal Study , Peterson & Seligman, 1988

Explanatory Style Change During Cognitive Therapy for Unipolar Depression, Seligman et al., 1988

Explanatory Style as a Predictor of Productivity and Quitting Among Life Insurance Sales Agents , Seligman and Schulman, 1986

Explanatory Style as a Mechanism of Disappointing Athletic Performance , Seligman et al., 1990

Explanatory Style and Academic Performance Among University Freshmen , Peterson & Barrett, 1987

Attributional Style in Depression: A Meta-Analytic Review , Sweeney, Anderson & Bailey, 1986

Learned Helplessness in Children: A Longitudinal Study of Depression, Achievement, and Explanatory Style, Nolen-Hoeksema, Girgus, & Seligman, 1986

Causal Explanations as a Risk Factor for Depression: Theory and Evidence, Peterson & Seligman, 1984

Learned helplessness in Humans: Critique and Reformulation, Abramson, Seligman, & Teasdale, 1978

Learned Helplessness: Theory and Evidence ,  Maier & Seligman, 1976

Learned Helplessness , Seligman, 1972

Positive Psychology Interventions Research:

Positive Psychology Progress: Empirical Validation of Interventions , Seligman, Steen, Park, & Peterson, 2005

Pursuing Happiness in Everyday Life: The Characteristics and Behaviors of Online Happiness Seekers , Parks et al., 2012

Disseminating Self-Help: Positive Psychology Exercises in an Online Trial , Schueller & Parks, 2012

Building Resilience , Harvard Business Review, Seligman, 2011

Character Strengths Research :

Christopher M. Peterson (Memoriam), Park & Seligman, 2013

Character Strengths Predict Subjective Well-Being During Adolescence, Gillham et al., 2011

Character Strengths: Research and Practice , Park & Peterson, 2009 

Strengths of Character, Orientations to Happiness, and Life Satisfaction , Peterson et al., 2007

Character Strengths in Fifty-Four Nations and the Fifty US States , Park, Peterson, & Seligman, 2006

Shared Virtue: The Convergence of Valued Human Strengths Across Culture and History, Dahlsgaard, Peterson, & Seligman, 2005

Strengths of Character and Well-Being , Park, Peterson & Seligman, 2004

Chris Peterson's Unfinished Masterwork: The Real Mental Illnesses , Seligman, 2013

Research on the VIA Institute Website

Positive Emotions Research :

Positive Emotions Broaden and Build , Fredrickson, 2013

Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life , Emmons & McCullough, 2003

The Grateful Disposition: A Conceptual and Empirical Topography , McCullough & Emmons, 2002

The Psychology of Forgiveness , McCullough & vanOyen Witvliet, 2001

Interpersonal Forgiving in Close Relationships: II. Theoretical Elaboration and Measurement , McCullough et al., 1998

Mindfulness Training Modifies Subsystems of Attention , Jha, Krompinger & Baime, 2007

Witnessing Excellence in Action: The ‘Other-Praising’ Emotions of Elevation, Gratitude, and Admiration , Algoe & Haidt, 2009

The Varieties of Self-Transcendent Experience , Yaden, Haidt, Hood, Vago, and Newberg, 2017

A Four-Factor Model of Perceived Control: Avoiding, Coping, Obtaining, and Savoring , Bryant, 1989

Engagement Research :

Flow Theory and Research , Nakamura & Csikszentmihalyi, 2009

Relationships Research :

What Do You Do When Things Go Right? The Intrapersonal and Interpersonal Benefits of Sharing Positive Events , Gable et al., 2004 

Meaning Research :

On the Meaning of Work: A Theoretical Integration and Review , Rosso, Dekas & Wrzesniewski, 2010 

Crafting a Job: Revisioning Employees as Active Crafters of Their Work , Wrzesniewski & Dutton, 2001

Jobs, Careers, and Callings: People’s Relations to Their Work , Wrzesniewski et al., 1997

The Development of Purpose During Adolescence , Damon, Menon & Bronk, 2003

Achievement Research :

The Science and Practice of Self-Control , Duckworth & Seligman, 2017

Self-Control and Grit: Related but Separable Determinants of Success , Duckworth & Gross, 2014

Grit: Perseverance and Passion for Long-Term Goals , Duckworth et al., 2007 

Self-Discipline Outdoes IQ in Predicting Academic Performance of Adolescents , Duckworth & Seligman, 2005

The Role of Deliberate Practice in the Acquisition of Expert Performance , Ericsson, Krampe & Tesch-Romer, 1993 

A Social-Cognitive Approach to Motivation and Personality , Dweck & Leggett, 1988

School-Based Resilience Interventions Research :

Positive Education  Seligman & Adler 2019

Positive Education, Seligman & Adler, 2018

Positive Education: Positive Psychology and Classroom Interventions , Seligman, Ernst, Gillham, Reivich, & Linkins, 2009

Group Prevention of Depression and Anxiety Symptoms , Seligman, Schulman, & Tryon, 2007

The Prevention of Depression and Anxiety , Seligman, Schulman, DeRubeis, & Hollon, 1999

Teaching Well-Being increases Academic Performance: Evidence from Bhutan , Mexico, and Peru, Adler, 2016

Physical Health Following a Cognitive-Behavioral Intervention , Buchanan, Gardenswartz, & Seligman, 1999

School-Based Prevention of Depressive Symptoms: A Randomized Controlled Study of the Effectiveness and Specificity of the Penn Resilience Program, Gillham et al., 2007

Prevention of Depressive Symptoms in School Children: Two Year Follow-Up , Gillham, Reivich, Jaycox, & Seligman, 1995

Prevention of Depressive Symptoms in School Children, Jaycox, Reivich, Gillham, & Seligman, 1994

A Meta-Analytic Review of the Penn Resiliency Program's Effect on Depressive Symptoms , Brunwasser, Gillham, & Kim, 2009

Primal World Beliefs:

Primal World Beliefs , Clifton et al., 2019

Parents Think, Incorrectly, that Teaching their Children the World is a Bad Place is Best for Them , Clifton & Meindl, 2021

Well-Being and the Arts:

Art Museums as Institutions for Human Flourishing , Cotter and Pawelski, 2021

Imagination Research :

Creativity and Aging: What We Can Make with What We Have Left , Seligman, Forgeard, & Kaufman, 2017

Openness/Intellect: The Core of the Creative Personality , Oleynick et al., 2017

How Social-Emotional Imagination Facilitates Deep Learning and Creativity in the Classroom ,, Gotlieb, Jahner, Immordino-Yang, & Kaufman, 2017

Cultivating the Social-Emotional Imagination in Gifted Education: Insights from Educational Neuroscience , Gotlieb, Hyde, Immordino-Yang, & Kaufman, 2017

Post-Traumatic Growth Research :

Posttraumatic Growth: Conceptual Foundations and Empirical Evidence , Tedeschi & Calhoun, 2004

Doors Opening: A Mechanism for Growth After Adversity, Roepke & Seligman, 2015

Positive Psychology and Therapy Research:

Cognitive Therapy and Research Special Issue: Positive Emotions and Cognitions in Clinical Psychology , June 2017

Positive Psychology in Clinical Practice , Duckworth, Steen, & Seligman, 2005

Positive Psychotherapy , Seligman, Rashid, & Parks, 2006

Positive Health Research : 

Positive Health , Seligman, 2008

Positive Health and Health Assets: Re-analysis of Longitudinal Datasets , Seligman et al., 2013

The Person-Event Data Environment: Leveraging Big Data for Studies of Psychological Strengths in Soldiers. Vie, Griffith, Scheier, Lester & Seligman, 2013

The U.S. Army Person-Event Data Environment: A Military-Civilian Big Data Enterprise, Vie et al., 2015

Initial Validation of the U.S. Army Global Assessment Tool , Vie, Scheier, Lester, & Seligman, 2016

Protective Effects of Psychological Strengths Against Psychiatric Disorders Among Soldiers, Shrestha et al., 2018

Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers, Hassett et al., 2019

PTSD: Catastrophizing in Combat as Risk and Protection, Seligman et al., 2019

Comparison of Cardiovascular Health Between US Army and Civilians. Shrestha et al., 2019

Optimism and Risk of Incident Hypertension: A Target for Primordial Prevention , Kubzansky et al., 2020

Development of Character Strengths Across the Deployment Cycle Among U.S. Army Soldiers , Chopik et al., 2020

Happy Soldiers are Highest Performers , Lester et al., 2021

Prospective Psychology:

We Aren't Built to Live in the Moment , Seligman & Tierney, 2017

Navigating into the Future or Driven by the Past , Seligman, Railton, Baumeister, & Sripada, 2013

Depression and Prospection , Roepke & Seligman, 2016

• Research article
• Open access
• Published: 08 February 2013

Positive psychology interventions: a meta-analysis of randomized controlled studies

• Linda Bolier 1 ,
• Merel Haverman 2 ,
• Gerben J Westerhof 3 ,
• Heleen Riper 4 , 5 ,
• Filip Smit 1 , 6 &
• Ernst Bohlmeijer 3  

BMC Public Health volume  13 , Article number:  119 ( 2013 ) Cite this article

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The use of positive psychological interventions may be considered as a complementary strategy in mental health promotion and treatment. The present article constitutes a meta-analytical study of the effectiveness of positive psychology interventions for the general public and for individuals with specific psychosocial problems.

We conducted a systematic literature search using PubMed, PsychInfo, the Cochrane register, and manual searches. Forty articles, describing 39 studies, totaling 6,139 participants, met the criteria for inclusion. The outcome measures used were subjective well-being, psychological well-being and depression. Positive psychology interventions included self-help interventions, group training and individual therapy.

The standardized mean difference was 0.34 for subjective well-being, 0.20 for psychological well-being and 0.23 for depression indicating small effects for positive psychology interventions. At follow-up from three to six months, effect sizes are small, but still significant for subjective well-being and psychological well-being, indicating that effects are fairly sustainable. Heterogeneity was rather high, due to the wide diversity of the studies included. Several variables moderated the impact on depression: Interventions were more effective if they were of longer duration, if recruitment was conducted via referral or hospital, if interventions were delivered to people with certain psychosocial problems and on an individual basis, and if the study design was of low quality. Moreover, indications for publication bias were found, and the quality of the studies varied considerably.

Conclusions

The results of this meta-analysis show that positive psychology interventions can be effective in the enhancement of subjective well-being and psychological well-being, as well as in helping to reduce depressive symptoms. Additional high-quality peer-reviewed studies in diverse (clinical) populations are needed to strengthen the evidence-base for positive psychology interventions.

Peer Review reports

Over the past few decades, many psychological treatments have been developed for common mental problems and disorders such as depression and anxiety. Effectiveness has been established for cognitive behavioral therapy [ 1 , 2 ], problem-solving therapy [ 3 ] and interpersonal therapy [ 4 ]. Preventive and early interventions, such as the Coping with Depression course [ 5 ], the Don’t Panic course [ 6 ] and Living Life to the Full [ 7 , 8 ] are also available. The existing evidence shows that the mental health care system has traditionally focused more on treatment of mental disorders than on prevention. However, it is recognized that mental health is more than just the absence of mental illness, as expressed in the World Health Organization’s definition of mental health:

Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community [ 9 ].

Under this definition well-being and positive functioning are core elements of mental health. It underscores that people can be free of mental illness and at the same time be unhappy and exhibit a high level of dysfunction in daily life [ 10 ]. Likewise, people with mental disorders, can be happy by coping well with their illness and enjoy a satisfactory quality of life [ 11 ]. Subjective well-being refers to a cognitive and/or affective appraisal of one’s own life as a whole [ 12 ]. Psychological well-being focuses on the optimal functioning of the individual and includes concepts such as mastery, hope and purpose in life [ 13 , 14 ]. The benefits of well-being are recorded both in cross-sectional and longitudinal research and include improved productivity at work, having more meaningful relationships and less health care uptake [ 15 , 16 ]. Well-being is also positively associated with better physical health [ 17 – 19 ]. It is possible that this association is mediated by a healthy lifestyle and a healthier immune system, which buffers the adverse influence of stress [ 20 ]. In addition, the available evidence suggests that well-being reduces the risk of developing mental symptoms and disorders [ 21 , 22 ] and helps reduce mortality risks in people with physical disease [ 23 ].

Seligman and Csikszentmihaly’s (2000) pioneered these principles of positive psychology in their well-known article entitled ‘Positive psychology: An introduction’, published in a special issue of the American Psychologist. They argued that a negative bias prevailed in psychology research, where the main focus was on negative emotions and treating mental health problems and disorders [ 24 ]. Although the basic concepts of well-being, happiness and human flourishing have been studied for some decades [ 12 , 25 – 27 ], there was a lack of evidence-based interventions [ 24 ]. Since the publication of Seligman and Csikszentmihaly’s seminal article, the positive psychology movement has grown rapidly. The ever-expanding International Positive Psychology Association is among the most extensive research networks in the world [ 28 ] and many clinicians and coaches embrace the body of thought that positive psychology has to offer.

Consequently, the number of evaluation studies has greatly increased over the past decade. Many of these studies demonstrated the efficacy of positive psychology interventions such as counting your blessings [ 29 , 30 ], practicing kindness [ 31 ], setting personal goals [ 32 , 33 ], expressing gratitude [ 30 , 34 ] and using personal strengths [ 30 ] to enhance well-being, and, in some cases, to alleviate depressive symptoms [ 30 ]. Many of these interventions are delivered in a self-help format. Sin and Lyubomirsky (2009) conducted a meta-analytical review of the evidence for the effectiveness of positive psychology interventions (PPIs). Their results show that PPIs can indeed be effective in enhancing well-being (r = 0.29, standardized mean difference Cohen’s d = 0.61) and help to reduce depressive symptom levels in clinical populations (r = 0.31, Cohen’s d = 0.65). However, this meta-analysis had some important limitations. First, the meta-analysis included both randomized studies and quasi-experimental studies. Second, study quality was not addressed as a potential effect moderator. In recent meta-analyses, it has been shown that the treatment effects of psychotherapy have been overestimated in lower quality studies [ 35 , 36 ]. The lack of clarity in the inclusion criteria constitutes a third limitation. Intervention studies, although related to positive psychology but not strictly developed within this new framework (e.g. mindfulness, life-review) were included in the meta-analysis. However, inclusion of these studies reduces the robustness of the results for pure positive psychology interventions.

Present study

The aim of the present study is to conduct a meta-analysis of the effects of specific positive psychology interventions in the general public and in people with specific psychosocial problems. Subjective well-being, psychological well-being and depressive symptoms were the outcome measures. Potential variables moderating the effectiveness of the interventions, such as intervention type, duration and quality of the research design, were also examined. This study will add to the existing literature and the above meta-analytical review [ 37 ] by 1) only including randomized controlled studies, 2) taking the methodological quality of the primary studies into account, 3) including the most recent studies (2009 – 2012), 4) analyzing not only post-test effects but also long-term effects at follow up, and 5) applying clear inclusion criteria for the type of interventions and study design.

Search strategy

A systematic literature search was carried out in PsychInfo, PubMed and the Cochrane Central Register of Controlled Trials, covering the period from 1998 (the start of the positive psychology movement) to November 2012. The search strategy was based on two key components: there should be a) a specific positive psychology intervention, and b) an outcome evaluation. The following MeSH terms and text words were used: “well-being” or “happiness” or “happy*”, “optimism”, “positive psychology” in combination with “intervention”, “treatment”, “therapy” and “prevention”. This was combined with terms related to outcome research: “effect*”, or “effic*”, or “outcome*”, or “evaluat*”. We also cross-checked the references from the studies retrieved, the earlier meta-analysis of Sin & Lyubomirsky (2009) and two other reviews of positive psychological interventions [ 38 , 39 ]. The search was restricted to peer-reviewed studies in the English language.

Selection of studies

Two reviewers (LB and MH) independently selected potentially eligible studies in two phases. At the first phase, selection was based on title and abstract, and at the second phase on the full-text article. All studies identified as potentially eligible by at least one of the reviewers during the first selection phase, were re-assessed at the second selection phase. During the second phase, disagreements between the reviewers were resolved by consensus. The inter-rater reliability (kappa) was 0.90.

The inclusion criteria were as follows:

Examination of the effects of a positive psychology intervention. A positive psychology intervention (PPI) was defined in accordance with Sin and Lyubomirsky’s (2009) article as a psychological intervention (training, exercise, therapy) primarily aimed at raising positive feelings, positive cognitions or positive behavior as opposed to interventions aiming to reduce symptoms, problems or disorders. The intervention should have been explicitly developed in line with the theoretical tradition of positive psychology (usually reported in the introduction section of an article).

Randomization of the study subjects (randomizing individuals, not groups) and the presence of a comparator condition (no intervention, placebo, care as usual).

Publication in a peer-reviewed journal.

At least one of the following are measured as outcomes: well-being (subjective well-being and/or psychological well-being) or depression (diagnosis or symptoms).

Sufficient statistics are reported to enable the calculation of standardized effect sizes.

If necessary, authors were contacted for supplementary data. We excluded studies that involved physical exercises aimed at the improvement of well-being, as well as mindfulness or meditation interventions, forgiveness therapy, life-review and reminiscence interventions. Furthermore, well-being interventions in diseased populations not explicitly grounded in positive psychology theory (‘coping with disease courses’) were excluded. Apart from being beyond the scope of this meta-analysis, extensive meta-analyses have already been published for these types of intervention [ 40 – 42 ]. This does not imply that these interventions do not have positive effects on well-being, a point which will be elaborated on in the discussion section of this paper.

Data extraction

Data extraction and study quality assessment were performed by one reviewer (LB) and independently checked by a second reviewer (MH). Disagreements were resolved by consensus. Data were collected on design, intervention characteristics, target group, recruitment methods, delivery mode, number of sessions, attrition rates, control group, outcome measures and effect sizes (post-test and at follow up of at least 3 months). The primary outcomes in our meta-analysis were subjective well-being (SWB), psychological well-being (PWB) and depressive symptoms/depression.

The methodological quality of the included studies was assessed using a short scale of six criteria tailored to those studies and based on criteria established by the Cochrane collaboration [ 43 ]: 1) Adequacy of randomization concealment, 2) Blinding of subjects to the condition (blinding of assessors was not applicable in most cases), 3) Baseline comparability: were study groups comparable at the beginning of the study and was this explicitly assessed? (Or were adjustments made to correct for baseline imbalance using appropriate covariates), 4) Power analysis: is there an adequate power analysis and/or are there at least 50 participants in the analysis?, 5) Completeness of follow up data: clear attrition analysis and loss to follow up < 50%, 6) Handling of missing data: the use of intention-to-treat analysis (as opposed to a completers-only analysis). Each criterion was rated as 0 (study does not meet criterion) or 1 (study meets criterion). The inter-rater reliability (kappa) was 0.91. The quality of a study was assessed as high when five or six criteria were met, medium when three or four criteria were met, and low when zero, one or two criteria were met. Along with a summary score, the aspects relating to quality were also considered individually, as results based on composite quality scales can be equivocal [ 44 ]. Table  1 shows the quality assessment for each study. The quality of the studies was scored from 1 to 5 (M = 2.56; SD = 1.25). Twenty studies were rated as low, 18 were of medium quality and one study was of high quality. None of the studies met all quality criteria. The average number of participants in the analysis was rather high (17 out of 39 studies scored positive on this criterion), although none of the studies reported an adequate power analysis. Also, baseline comparability was frequently reported (26/39 studies). On the other hand, independence in the randomization procedure was seldom reported (7/39 studies) and an intention-to-treat analysis was rarely conducted (3/39 studies).

• Meta-analysis

In a meta-analysis, the effects found in the primary studies are converted into a standardized effect size, which is no longer placed on the original measurement scale, and can therefore be compared with measures from other scales. For each study, we calculated effect sizes (Cohen’s d ) by subtracting the average score of the experimental group (Me) from the average score of the control group (Mc), and dividing the result by the pooled standard deviations of both groups. This was done at post-test because randomization usually results in comparable groups across conditions at baseline. However, if baseline differences on outcome variables did exist despite the randomization, d’s were calculated on the basis of pre- post-test differences: by calculating the standardized pre- post change score for the experimental group (de) and the control group (dc) and subsequently calculating their difference as Δd= de – dc. For example, an effect size of 0.5 indicates that the mean of the experimental group is half a standard unit (standard deviation) larger than the mean of the control group. From a clinical perspective, effect sizes of 0.56 – 1.2 can be interpreted as large, while effect sizes of 0.33 – 0.55 are of medium size, and effects of 0 – 0.32 are small [ 45 ].

In the calculation of effect sizes for depression, we used instruments that explicitly measure depression (e.g. the Beck Depression Inventory, or the Center for Epidemiological Studies Depression Scale). For subjective and psychological well-being, we also used instruments related to the construct of well-being (such as positive affect for SWB and hope for PWB). If more than one measure was used for SWB, PWB or depression, the mean of the effect sizes was calculated, so that each study outcome had one effect size. If more than one experimental group was compared with a control condition in a particular study, the number of subjects in the control groups was evenly divided across the experimental groups so that each subject was used only once in the meta-analysis.

To calculate pooled mean effect sizes, we used Comprehensive Meta-Analysis (CMA, Version 2.2.064). Due to the diversity of studies and populations, a common effect size was not assumed and we expected considerable heterogeneity. Therefore, it was decided a priori to use the ‘random effects model’. Effect sizes may differ under this model, not only because of random error within studies (as in the fixed effects model), but also as a result of true variation in effect sizes between studies. The outcomes of the random effects model are conservative in that their 95% Confidence Intervals (CIs) are often broad, thus reducing the likelihood of type-II errors.

We tested for the presence of heterogeneity with two indicators. First, we calculated the Q-statistic. A significant Q rejects the null-hypothesis of homogeneity and indicates that the true effect size probably does vary from study to study. Second, the I 2 -statistic was calculated. This is a percentage indicating the study-to-study dispersion due to real differences, over and above random sampling error. A value of 0% indicates an absence of dispersion, and larger values show increasing levels of heterogeneity where 25% can be considered as low, 50% as moderate and 75% as a high level of heterogeneity [ 46 ].

Owing to the expected high level of heterogeneity, all studies were taken into account. Outliers were considered, but not automatically removed from the meta-analysis. The procedure of removing outliers which are outside the confidence interval of the pooled effect size is advised when a common effect size is assumed. However, in our meta-analysis, high dispersion was expected and therefore only the exclusion of Cohen’s d > 2.5 from the final sample was planned.

Subgroup analyses were performed by testing differences in Cohen’s d’s between subgroups. Six potential moderators were determined based on previous research and the characteristics of the investigated interventions and studies: 1) Self-selected sample/not self-selected: did the participants know that the aim of the intervention was to make them feel better?; 2) Duration: less than four weeks, four to eight weeks, or more than eight weeks; 3) Type of intervention: self-help, group intervention, or individual therapy; 4) Recruitment method: community (in a community center, local newspapers), internet, by referral/hospital, at university; 5) Psychosocial problems (Yes/none): was the data based on a group with certain psychosocial problems or was the study open to everyone?; 6) Quality rating: low (score 1 or 2), medium (score 3 or 4) or high (score 5 or 6). The impact of the duration and quality ratings was also assessed using meta-regression.

Results of meta-analysis may be biased due to the fact that studies with non-significant or negative results are less likely to be published in peer-reviewed journals [ 47 ]. In order to address this issue, we used three indices: funnel plots, the Orwin’s fail-safe number and the Trim and Fill method. A funnel plot is a graph of effect size against study size. When publication bias is absent, the observed studies are expected to be distributed symmetrically around the pooled effect size. The Orwin’s fail-safe number indicates the number of non-significant unpublished studies needed to reduce the overall significant effect to non-significance (according to a self-stated criterium) [ 48 ]. The effect size can be considered to be robust if the number of studies required to reduce the overall effect size to a non-significant level exceeds 5 K + 10, where K is the number of studies included. If asymmetry is found in the funnel plot, the Trim and Fill method adjusts the pooled effect size for the outcomes of missing studies [ 49 ]. Imputing missing studies restores the symmetry in the funnel plot and an adjusted effect size can be calculated.

For the reporting of the results of this meta-analysis, we applied Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 50 ].

Description of studies

The selection process is illustrated in Figure  1 . First, 5,335 titles were retrieved from databases and 55 titles were identified through searching the reference list accompanying the meta-analysis by Sin and Lyubomirsky (2009) [ 37 ] as well as two other literature reviews of positive psychological interventions [ 38 , 39 ]. After reviewing the titles and abstracts and removing duplicates, 84 articles were identified as being potentially eligible for inclusion in our study. Of these 84 articles, 40 articles in which 39 studies were described, met our inclusion criteria (of these, 17 articles describing 19 studies were also included in the meta-analysis by Sin and Lyubomirsky, 2009). In two articles [ 29 , 51 ] two studies were described, and one study [ 52 – 55 ] was published in four articles.

Flow diagram.

The characteristics of the studies included are described in Table  2 . The studies evaluated 6,139 subjects, 4,043 in PPI groups and 2,096 in control groups. Ten studies compared a PPI with a no-intervention control group [ 29 , 51 , 56 – 63 ], 17 studies compared a PPI with a placebo intervention [ 29 , 30 , 32 , 34 , 52 – 55 , 64 – 75 ], seven studies with a waiting list control group [ 33 , 76 – 81 ] and five studies with another active intervention (care as usual) [ 51 , 82 – 85 ]. A minority of seven studies [ 51 , 57 , 76 , 77 , 82 , 83 ] applied inclusion criteria to target a specific group with psychosocial problems such as depression and anxiety symptoms. Half of the studies, 19 in total, recruited the subjects (not necessarily students) through university [ 29 , 32 , 34 , 51 , 56 , 58 – 61 , 64 – 68 , 70 , 72 , 75 , 80 , 85 ]. In seven studies subjects were recruited in the community [ 33 , 57 , 71 , 73 , 76 , 77 , 81 ], in four studies by referral from a practitioner or hospital [ 29 , 51 , 82 , 83 ], in three studies in an organization [ 62 , 78 , 79 ] and six studies recruited through the internet [ 30 , 52 – 55 , 63 , 69 , 74 , 84 ]. Twenty-eight studies measured subjective well-being, 20 studied psychological well-being and 14 studied depressive symptoms. Half of the studies (20) were aimed at adult populations [ 29 , 30 , 33 , 51 – 56 , 62 , 63 , 65 , 69 , 71 , 73 , 74 , 76 , 78 , 79 , 81 – 84 ]. A substantial number of studies (17) were aimed at college students [ 29 , 32 , 34 , 51 , 58 – 61 , 64 , 66 – 68 , 70 , 72 , 75 , 80 , 85 ] and two studies were aimed at older subjects [ 57 , 77 ]. In most studies (26) the PPI was delivered in the form of self-help [ 29 , 30 , 34 , 52 – 56 , 58 , 59 , 61 , 63 – 71 , 73 – 75 , 77 , 78 , 80 , 84 , 85 ]. Eight studies used group PPIs [ 32 , 33 , 51 , 57 , 60 , 62 , 72 , 76 ] and five used individual PPIs [ 51 , 79 , 81 – 83 ]. Intensity varied considerably across studies, ranging from a short one-day exercise [ 70 ] and a two-week self-help intervention [ 65 ] to intensive therapy [ 51 , 82 , 83 ] and coaching [ 33 , 81 ].

Post-test effects

The random effect model showed that the PPIs were effective for all three outcomes. Results are presented in Table  3 . The effect sizes of the individual studies at post-test are plotted in Figures  2 , 3 and 4 .

Post-test effects of positive psychology interventions on subjective well-being. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

Post-test effects of positive psychology interventions on psychological well-being. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

Post-test effects of positive psychology interventions on depressive symptoms. The square boxes show effect size and sample size (the larger the box, the larger the sample size) in each study, and the line the 95% confidence interval. The diamond reflects the pooled effect size and the width of the 95% confidence interval.

A composite moderate and statistically significant effect size (Cohen’s d ) was observed for subjective well-being d = 0.34 (95% CI [0.22, 0.45], p<.01). For psychological well-being, Cohen’s d was 0.20 (95% CI [0.09, 0.30], p<.01) and for depression d = 0.23 (95% CI [0.09, 0.38], p<.01), which can be considered as small.

Heterogeneity was moderate for subjective well-being (I 2 = 49.5%) and depression (I 2 = 47.0%), and low for psychological well-being (I 2 = 29.0%). Effect sizes ranged from −0.09 [ 66 ] to 1.30 [ 64 ] for subjective well-being, -0.06 [ 78 ] to 2.4 [ 83 ] for psychological well-being and −0.17 [ 69 ] to 1.75 [ 83 ] for depression.

Removing outliers reduced effect sizes for all three outcomes: 0.26 (95% CI [0.18, 0.33], Z=6.43, p<.01) for subjective well-being (Burton & King, 2004 and Peters et al., 2010 removed) [ 64 , 70 ], 0.17 (95% CI [0.09, 0.25], Z=4.18, p<.01) for psychological well-being (Fava et al. (2005) removed) [ 83 ] and 0.18 (95% CI [0.07, 0.28], Z=3.33, p<.01) for depression (Fava, 2005 and Seligman, 2006 study 2, removed) [ 51 , 83 ]. Removing the outliers reduced heterogeneity substantially (to a non-significant level).

Follow-up effects

Ten studies examined follow-up effects after at least three months and up to 12 months (Table  3 ). For the purposes of interpretation, we used only those studies examining effects from three to six months (short-term follow-up), thus excluding Fava et al. (2005) [ 83 ] which had a follow-up at one year. The random-effects model demonstrated small but significant effects in comparison with the control groups for subjective well-being (Cohen’s d 0.22, 95% CI [0.05, 0.38], p<.01) and for psychological well-being (0.16, 95% CI [0.02, 0.30], p = .03). The effect was not significant for depression (0.17, 95% CI [−0.06, 0.39], p = .15). Heterogeneity was low for subjective well-being (I 2 = 1.1%) and psychological well-being (I 2 = 26.0%), and high for depression (I 2 = 63.9%).

Subgroup analyses

Subgroup analyses are presented in Table  4 . We looked at self-selection, duration of the intervention, type of intervention, recruitment method, application of inclusion criteria related to certain psychosocial problems, and quality rating.

For depression, five out of six subgroups of studies resulted in significantly higher effect sizes. Higher effect sizes were found for 1) interventions of a longer duration (only in the meta regression analysis), 2) individual interventions, 3) studies involving referral from a health care practitioner or hospital, 4) studies which applied inclusion criteria based on psychosocial problems and 5) lower quality studies. For subjective well-being and psychological well-being, there were no significant differences between subgroups, although for the latter there was a recognizable trend in the same direction and on the same moderators, except for quality rating.

Twenty-six out of 39 studies were self-help interventions for which we conducted a separate subgroup analysis. However, there was little diversity within the self-help subgroup: only six studies examined intensive self-help for longer than four weeks, self-help was offered to people with specific psychosocial problems in only one study and more than half of the self-help studies (n=14) recruited their participants via university. Consequently, there were no significant differences between subgroups for self-help interventions.

Publication bias

Indications for publication bias were found for all outcome measures, but to a lesser extent for subjective well-being. Funnel plots were asymmetrically distributed in such a way that the smaller studies often showed the more positive results (in other words, there is a certain lack of small insignificant studies). Orwin’s fail-safe numbers based on a criterium effect size of 0.10 for subjective well-being (59), psychological well-being (16) and depression (13) were lower than required (respectively 150, 110 and 80). Egger’s regression intercept also suggests that publication bias exists for psychological well-being (intercept=1.18, t=2.26, df=18, p=.04) and depression (intercept=1.45, t=2.26, df=12, p=.03), but not for subjective well-being (intercept=1.20, t=1.55, df=26, p=0.13). The mean effect sizes of psychological well-being and depression were therefore recalculated by imputing missing studies using the Trim and Fill method. For psychological well-being, three studies were imputed and the effect size was adjusted to 0.16 (95% CI 0.03-0.29). For depression, five studies were imputed and the adjusted effect size was 0.16 (95% CI 0.00-0.32).

Main findings

This meta-analysis synthesized effectiveness studies on positive psychology interventions. Following a systematic literature search, 40 articles describing 39 studies were included. Results showed that positive psychology interventions significantly enhance subjective and psychological well-being and reduce depressive symptoms. Effect sizes were in the small to moderate range. The mean effect size on subjective well-being was 0.34, 0.20 on psychological well-being, and 0.23 on depression. Effect sizes varied a great deal between studies, ranging from below 0 (indicating a negative effect) to 2.4 (indicating a very large effect). Moreover, at follow-up from three to six months, small but still significant effects were found for subjective well-being and psychological well-being, indicating that effects were partly sustained over time. These follow-up results should be treated with caution because of the small number of studies and the high attrition rates at follow-up.

Remarkably, effect sizes in the current meta-analysis are around 0.3 points lower than the effect sizes in the meta-analysis by Sin and Lyubomirsky (2009) [ 37 ]. We included a different set of studies in which the design quality was assured using randomized controlled trials only. Effectiveness research in psychotherapy shows that effect sizes are relatively small in high-quality studies compared with low-quality studies [ 35 ] and this might also be true for positive psychology interventions. In addition, we applied stricter inclusion criteria than those used by Sin and Lyubomirsky (2009) and therefore did not include studies on any related areas such as mindfulness and life review therapy. These types of interventions stem from long-standing independent research traditions for which effectiveness has already been established in several meta-analyses [ 40 , 41 ]. Also, the most recent studies were included. This might explain the overestimation of effect sizes in the meta-analysis by Sin and Lyubomirsky (2009).

Several characteristics of the study moderated the effect on depressive symptoms. Larger effects were found in interventions with a longer duration, in individual interventions (compared with self-help), when the interventions were offered to people with certain psychosocial problems and when recruitment was carried out via referral from a health care professional or hospital. Quality rating also moderated the effect on depression: the higher the quality, the smaller the effect. Interestingly, these characteristics did not significantly moderate subjective well-being and psychological well-being. However, there was a trend in the moderation of psychological well-being that was the same as that observed in the studies which included depression as an outcome. In general, effectiveness was increased when interventions were offered over a longer period, face-to-face on an individual basis in people experiencing psychosocial problems and when participants were recruited via the health care system.

Although it is clear that more intensive and face-to-face interventions generate larger effects, the effects of short-term self-help interventions are small but significant. From a public health perspective, self-help interventions can serve as cost-effective mental health promotion tools to reach large target groups which may not otherwise be reached [ 86 – 88 ]. Even interventions presenting small effect sizes can in theory have a major impact on populations’ well-being when many people are reached [ 89 ]. The majority of positive psychology interventions (in our study 26 out of 39 studies) are already delivered in a self-help format, sometimes in conjunction with face-to-face instruction and support. Apparently, self-help suits the goals of positive psychology very well and it would be very interesting to learn more about how to improve the effectiveness of PPI self-help interventions. However, a separate subgroup analysis on the self-help subgroup revealed no significant differences in the present meta-analysis. There was very little variation in the subgroups as regards population, duration of the intervention and recruitment method. As a result, this analysis does not give firm indications on how to improve the effectiveness of self-help interventions. It is possible that self-help could be enhanced by offering interventions to people with specific psychosocial problems, increasing the intensity of the intervention and embedding the interventions in the health care system. However, more studies in diverse populations, settings and with varying intensity are needed before we can begin to derive recommendations from this type of meta-analysis. Other research gives several additional indications on how to boost the efficacy of self-help interventions. Adherence tends to be quite low in self-help interventions [ 90 , 91 ] and therefore, enhancing adherence could be a major factor in improving effectiveness. Self-help often takes a ‘one size fits all’ approach, which may not be appropriate for a large group of people who will, as a consequence, not fully adhere to the intervention. Personalization and tailoring self-help interventions to individual needs [ 92 ] as well interactive support [ 93 ] might contribute to increased adherence and likewise improved effectiveness of (internet) self-help interventions.

Study limitations

This study has several limitations. First, the quality of the studies was not high, and no study met all of our quality criteria. For example, the randomization procedure was unclear in many studies. Also, most studies conducted completers-only analysis, as opposed to intention-to-treat analysis. This could have seriously biased the results [ 35 ]. However, the low quality of the studies could have been overstated as the criteria were scored conservatively: we gave a negative score when a criterion was not reported. Even so, more high-quality randomized-controlled trials are needed to enable more robust conclusions about the effects of PPIs. Second, different types of interventions are lumped together as positive psychology interventions, despite the strict inclusion criteria we applied. As expected, we found a rather high level of heterogeneity. In the future, it might be wise and meaningful to conduct meta-analyses that are restricted to specific types of interventions, for example gratitude interventions, strengths-based interventions and well-being therapy, just as has already been carried out with, for example, mindfulness and life review. In the present meta-analysis, studies on these specific interventions were too small and too diverse to allow for a subgroup-analysis. Third, the exclusion of non peer-reviewed articles and grey literature could have led to bias, and possibly also to the publication bias we found in our study. Fourth, although we included a relatively large number of studies in the meta-analysis, the number of studies in some subgroups was still small. Again, more randomized-controlled trials are needed to draw firmer conclusions. Sixth, the study of positive education is an emerging field in positive psychology [ 94 – 98 ] but school-based interventions were excluded from our meta-analysis due to the strict application of the inclusion criteria (only studies with randomization at individual level were included).

This meta-analysis demonstrates that positive psychology interventions can be effective in the enhancement of subjective and psychological well-being and may help to reduce depressive symptom levels. Results indicate that the effects are partly sustained at short-term follow-up. Although effect sizes are smaller in our meta-analysis, these results can be seen as a confirmation of the earlier meta-analysis by Sin and Lyubomirsky (2009). Interpretation of our findings should take account of the limitations discussed above and the indications for publication bias.

Implications for practice

In mental health care PPIs can be used in conjunction with problem-based preventive interventions and treatment. This combination of interventions might be appropriate when clients are in remission; positive psychology interventions may then be used to strengthen psychological and social recourses, build up resilience and prepare for normal life again. On the basis of the moderator analysis, we would recommend the delivery of interventions over a longer period (at least four weeks and preferably eight weeks or longer) and on an individual basis. Practitioners can tailor their treatment strategy to the needs and preferences of a client and can use positive psychology exercises in combination with other evidence-based interventions that have a positive approach and aim to enhance well-being, such as mindfulness interventions [ 40 ], Acceptance and Commitment Therapy [ 7 , 99 ], forgiveness interventions [ 42 ], behavioral-activation [ 100 ] and reminiscence [ 41 , 101 ].

In the context of public health, positive psychology interventions can be used as preventive, easily accessible and non-stigmatizing tools. They can potentially be used in two ways: 1) in mental health promotion (e.g. leaflets distributed for free at community centers, (mental) health internet portals containing psycho-education), and 2) as a first step in a stepped care approach. In the stepped care model, clients start with a low-intensity intervention if possible, preferably a self-directed intervention. These interventions can be either guided by a professional or unguided, and are increasingly delivered over the internet. Clinical outcomes can be monitored and people can be provided with more intensive forms of treatment, or referred to specialized care, if the first-step intervention does not result in the desired outcome [ 102 ].

Recommendations for research

Regarding the research agenda, there is a need for more high-quality studies, and more studies in diverse (clinical) populations and diverse intervention formats to know what works for whom. Standards for reporting studies should also be given more attention, for example by reporting randomized controlled trials according to the CONSORT statement [ 103 ]. In addition, we encourage researchers to publish in peer-reviewed journals, even when the sample sizes are small or when there is a null finding of no effect, as this is likely to reduce the publication bias in positive psychology. Furthermore, most studies are conducted in North America. Therefore, replications are needed in other countries and cultures because some positive psychology concepts may require adaptation to other cultures and outlooks (e.g. see Martinez et al., 2010) [ 68 ]. Last but not least, we strongly recommend conducting cost-effectiveness studies aiming to establish the societal and public health impact of positive psychology interventions. This type of information is likely to help policy makers decide whether positive psychology interventions offer good value for money and should therefore be placed on the mental health agenda for the 21 st century.

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Acknowledgements

We are grateful to Toine Ketelaars and Angita Peterse for the literature search and Jan Walburg for his comments on the manuscript. We would also like to thank Deirdre Brophy for the English language edit.

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The EMGO institute for Health and Care research, VU University, Amsterdam, The Netherlands

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Innovation Incubator, Leuphana University, Lueneburg, Germany

Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

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LB conducted the meta-analysis, including the literature selection and data-analysis, and wrote the manuscript. MH took care of selecting the articles and cross-checking the data. All authors contributed to the design of the study. EB, GW, HR and FS are advisors in the project. All authors provided comments and approved the final manuscript.

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Bolier, L., Haverman, M., Westerhof, G.J. et al. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 13 , 119 (2013). https://doi.org/10.1186/1471-2458-13-119

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Research Article

A qualitative study of positive psychological experiences and helpful coping behaviours among young people and older adults in the UK during the COVID-19 pandemic

Roles Formal analysis, Investigation, Methodology, Project administration, Writing – original draft

Affiliation Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London, United Kingdom

Roles Investigation, Supervision, Writing – review & editing

Roles Conceptualization, Writing – review & editing

Roles Conceptualization, Funding acquisition, Writing – review & editing

Roles Conceptualization, Methodology, Resources, Supervision, Writing – review & editing

* E-mail: [email protected]

• Liyann Ooi, 
• Elise Paul, 
• Alexandra Burton, 
• Daisy Fancourt, 
• Alison R. McKinlay

• Published: January 23, 2023
• https://doi.org/10.1371/journal.pone.0279205
• Peer Review
• Reader Comments

While much research has focused on challenges that younger and older people have faced during the COVID-19 pandemic, little attention has been given to the capacity for resilience among these groups. We therefore explored positive psychological experiences and coping behaviours that protected mental health and well-being. Participants were 40 young people (aged 13–24) and 28 older adults (aged 70+) living in the UK during the COVID-19 pandemic. Interviews were held between May 2020 and January 2021. We generated six themes using qualitative thematic analysis, including: engagement in self-fulfilling activities, increased sense of social cohesion, personal growth, use of problem-focused strategies to manage pandemic-related stressors, giving and receiving social and community support, and utilising strategies to regulate thoughts and emotions. While all six themes were relevant both to younger and older adults, there were nuances in how each was experienced and enacted. For example, many older adults adjusted their routines given worries about virus vulnerability, while some young people experienced greater personal growth amidst increased awareness of mental health as they navigated the various lockdown restrictions.

Citation: Ooi L, Paul E, Burton A, Fancourt D, McKinlay AR (2023) A qualitative study of positive psychological experiences and helpful coping behaviours among young people and older adults in the UK during the COVID-19 pandemic. PLoS ONE 18(1): e0279205. https://doi.org/10.1371/journal.pone.0279205

Editor: Eleni Petkari, Universidad Internacional de La Rioja, SPAIN

Received: August 10, 2022; Accepted: December 2, 2022; Published: January 23, 2023

Copyright: © 2023 Ooi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The full dataset cannot be shared publicly because of the ethical risk that this would compromise participant confidentiality and anonymity. The minimal dataset containing a summary of anonymised participant quotes can be accessed in Supplementary material for this research article.

Funding: This research was supported by Nuffield Foundation [WEL/FR-000022583], but the views expressed are those of the authors and not necessarily the Foundation. The study was also supported by the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and by the Wellcome Trust [221400/Z/20/Z]. DF was funded by the Wellcome Trust [205407/Z/16/Z]. DF is the Principal investigator, award manager, etc of all funding mentioned in the financial disclosure statement The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors declare no competing interests.

Introduction

During the novel coronavirus (COVID-19) pandemic, the first UK lockdown was imposed in March 2020 [ 1 ], with people being ordered to stay at home unless for essential reasons such as grocery shopping or exercise. People aged over 70 were at first classified as especially vulnerable to the virus [ 2 ] and advised to stay at home earlier than other age groups at the start of the pandemic, while young people faced their own unique challenges owing to closures of schools, universities, and workplaces. Evidence suggests that many people in the UK experienced heightened levels of stress, anxiety and fear during the pandemic [ 3 , 4 ]. However, younger people on average scored highest on measures of loneliness, depression, anxiety, while older adults scored the lowest [ 5 ]. Nonetheless, many older adults still experienced complex and adverse psychological responses to events, including depression linked to loneliness [ 6 ] and fear arising from perceived lack of health service availability during the pandemic [ 7 ]. Concerns have been raised regarding the disproportionate, long-term psychosocial impacts of COVID-19 on both younger and older adults [ 8 , 9 ]. Taken together, these factors point to a need for further exploration into the factors that helped buffer the consequences resulting from the pandemic affecting these groups. Such research is important for understanding why some people managed to cope better than others, and for preparing for potential future pandemics.

A narrative review on other infectious disease outbreaks over the last two decades indicated that while adverse psychological consequences were common in previous pandemics, positive psychological experiences were also reported and various coping strategies were used to help deal with the unique challenges of an outbreak [ 10 ]. Such positive psychological experiences may include positive emotional, cognitive, social, and behavioural functioning [ 11 ]. For example, amid the SARS pandemic, it was reported that some people engaged in healthier lifestyle behaviours and cared more for their own mental health [ 12 , 13 ]. In the early stages of the COVID-19 pandemic, quantitative findings indicate that people had more opportunities to explore new hobbies, enjoyed more time outdoors and developed greater gratitude for personal relationships [ 14 , 15 ].

Qualitative research also highlights how people may interpret their pandemic experience positively, including having a greater sense of solidarity with others [ 16 ], and a sense of empowerment from increased lifestyle flexibility [ 17 ]. The PERMA model of positive psychology [ 18 ], which encapsulates positive emotion, engagement, relationships, meaning and achievement, has been used to describe aspects of positive well-being and may be useful when interpreting the positive responses people have reported during the COVID-19 pandemic. However, it has been argued that the model’s conceptualisation of well-being does not explicitly address the management of negative emotions pertinent to adverse circumstances of the pandemic [ 19 ]. Therefore, recognising positive psychological experiences across domains of the PERMA model in tandem with how individuals deal with negative stressors, may provide a more holistic understanding of well-being of people in younger and older age groups during the pandemic.

How people deal with stressors reflect the concept of coping—crucial psychological and behavioural factors for how individuals draw on behavioural and cognitive efforts to manage stress [ 20 ]. Various coping strategies have been theoretically identified [ 21 ], including problem-focused coping (i.e., use of planning, restraint, or social support for practical reasons) and emotion-focused coping (i.e., acceptance, denial, positive reinterpretation, or social support for emotions). In the COVID-19 pandemic, the use of socially supported coping (i.e., drawing on social support) has been found to be especially linked with greater improvements in mental health during earlier stages of lockdown restrictions [ 22 ], which highlights the key role of social networks in the maintenance of well-being [ 23 ]. Moreover, some individual behaviours, such as those involving outdoor activities, have been shown to predict better well-being during the pandemic [ 24 ]. Hence the coping behaviours that people engaged in during the pandemic may protect well-being in a way that cuts across and transcends certain coping styles. Furthermore, understanding coping behaviours that individuals perceive as helpful in managing the unique challenges of the pandemic may offer valuable insights into resilience levels during the pandemic.

An evolving body of research suggests that the positive psychological experiences and coping behaviours which protect mental health and well-being during the pandemic may differ across age. In one UK study, young people demonstrated a significantly higher level of positive lifestyle changes than older adults across several domains, such as increased quality time with family, and increased physical exercise [ 15 ]. However, when compared to older adults, young people reported greater psychosocial difficulties and more adverse mental health consequences[ 25 , 26 ], and some have postulated that part of this is due to significant lifestyle changes owing to the pandemic [ 27 ], precarious employment [ 28 ] and education interuptions affecting long-term career planning [ 29 ]. Nonetheless, it has been observed that young people appeared to show quicker recovery from their symptoms compared to older adults during the initial stages of pandemic restrictions in the UK [ 30 ], thereby reflecting the potential for resilience of young people and the need to understand how older adults can be better supported over the longer term. Emerging qualitative findings have lent support to the premise of resilience of older adults and young people respectively as both groups drew on pre-existing and new coping strategies to protect their well-being during the pandemic [ 31 ]. Greater sense of coherence (SOC), which encapsulates an individual’s ability to comprehend, manage and make sense of a new health threat, has been found to support well-being [ 32 ]. While it has been argued that SOC strengthens with age, adverse health impacts in old age may moderate SOC among older adults [ 33 ], hence age-related factors may influence capacity to cope with some of life’s adversities.

Limited studies to date have explored in depth the experiences of young people and older adults during the COVID-19 pandemic through a positive psychology lens, to investigate the resources that people draw on to support themselves through pandemic-related distress. To address these gaps in the literature, we sought to answer the following question: “what were the positive psychological experiences or coping behaviours that protected mental health and well-being of young people and older adults living in the UK during the COVID-19 pandemic?”

This study forms part of the University College London (UCL) COVID-19 Social Study (CSS), which was the largest panel survey and qualitative interview study of the psychological and social experiences of people in the UK during the COVID-19 pandemic [ 34 ]. For the current study, we performed secondary qualitative analysis of 68 interview transcripts reporting the perspectives and experiences of young people (aged 13–24) and older adults (aged 70+). This paper follows the Standards for Reporting Qualitative Research (SRQR) reporting guidelines [ 35 ].

Participants were recruited through the CSS e-newsletter, social media, personal contacts, and partner organisations (i.e., third sector services) working with older adults or young people. Eligibility criteria included: aged 70+ or 13–24, living in the UK, and fluent in English. Given the link between certain demographic factors and mental health during the pandemic [ 30 ], convenience and purposive sampling strategies were employed to include individuals of diverse age, ethnicity, sex, marital status, living situation and employment status. All participants completed a self-report demographics questionnaire on age, ethnicity, sex, marital status, living situation, employment status, physical and mental health conditions. Semi-structured, one-to-one interviews, lasting between 14 to 85 minutes ( M = 45 minutes) were conducted between May 2020 and January 2021, which included the first and second national lockdown in the UK where people experienced cycles of tightened and eased pandemic-related measures (see S1 Table ). Interviews were conducted by postgraduate-level, male and female, qualitative health researchers via telephone or video call.

Interviews followed a Topic Guide (see S1 Fig ) designed to encompass a range of topics which have been covered in other papers with young people and older adults [ 7 , 29 , 36 ]. The Topic Guide was developed from supporting theory regarding social networks and SOC [ 23 , 32 ]. Specific questions were asked to elicit responses on positive experiences during the pandemic and behaviours that helped people cope (see S2 Fig ), which formed the focus of this study–although participants also spoke of factors negatively impacting well-being which are reported elsewhere [ 7 , 29 ]. Participants were offered a £10 shopping voucher as a token of gratitude.

Research ethics

Ethical approval for the study and research procedure was obtained from the UCL High Risk Ethics Committee (ProjectID:14895/005). We followed best practice guidelines outlined by the Health Research Authority for research involving children and young people when developing our research protocol for obtaining participant consent [ 37 ]. We sought written informed consent from participants aged 16 and over. In cases where participants were aged 13–15, they were asked to provide their verbal and written assent and have a parent provide their verbal and written informed consent. All data were held securely and confidentially. Our research protocols were aligned with the principles of the Declaration of Helsinki [ 38 ].

Data analysis

Interviews were audio-recorded, then transcribed verbatim. Transcripts were checked before importing into NVivo 12 [ 39 ]. We carried out qualitative thematic analysis with a predominantly deductive and theory-driven orientation during theme and code development [ 40 ]. In contrast to “Big Q” qualitative research, which tends to be more exploratory and inductive in nature [ 41 ], our analysis practices aligned more closely with structured, postpositivist-leaning “small q” qualitative research as distinguished by Braun and Clarke (2021) [ 42 ]. The lead author (LO) read through all transcripts to ensure completeness of data analysis. While LO coded all transcripts, a second researcher (AM) double-coded three transcripts at the beginning of data analysis and both authors reviewed these identified codes to ensure consistency before completing the remainder of the coding. A deductive coding approach was initially used, whereby a coding framework was first established based on supporting theory on positive psychology and coping [ 18 , 21 ], and this framework was applied to each transcript through line-by-line coding. The coding framework was then refined iteratively as new concepts were identified by LO. Contradictory remarks and context surrounding codes were noted to draw out subtle nuances. Codes that share a common meaning or concept relevant to the research question were clustered to create themes. Themes and subthemes were developed and regularly discussed between three researchers (LO, EP and AM) throughout the analysis stage to ensure appropriate categorisation of codes. NVivo Crosstab query was used to facilitate analysis of themes across the two age groups.

Participants were 28 older adults aged 70 to 93 years ( M = 77.1, SD = 5.9) and 40 young people aged 13 to 24 years ( M = 18.3, SD = 3.4). The majority of participants were White British (75%) and female (57%). Among younger participants, most were in secondary school or university (76%) and living with parent(s) (73%). Among older participants, most were retired (79%) and half were living with a partner/spouse (50%). Forty participants reported having existing physical ( n = 31) and/or mental health condition(s) ( n = 12). Participant characteristics are summarised in Table 1 .

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https://doi.org/10.1371/journal.pone.0279205.t001

Themes and corresponding sub-themes on positive psychological experiences and helpful coping behaviours are illustrated in Tables 2 and 3 respectively and described below. Many participants described several positive psychological experiences including engagement in self-fulfilling activities, increased sense of social cohesion and greater personal growth. In addition, many spoke of engaging in various helpful coping behaviours including use of problem-focused strategies to manage pandemic-related stressors, strategies to regulate thoughts and emotions, as well as giving and receiving social and community support.

https://doi.org/10.1371/journal.pone.0279205.t002

https://doi.org/10.1371/journal.pone.0279205.t003

Positive psychological experiences

1 engagement in self-fulfilling activities..

1 . 1 Opportunity for leisure and exploration of new skills . Many participants described enjoying more free time for leisure and to develop new skills, leading to feelings of improved well-being and satisfaction levels. Among older participants, some found that a slower pace of life during the pandemic allowed them to rekindle old hobbies and immerse themselves in leisure activities: ‘I’ve always loved reading so I’ve been able to get on with as much reading as I want . …to actually just sit for a couple of hours reading and not feel guilty . ’ (P06, aged 70–74)

Among younger participants, some expressed a renewed sense of competence being able to sharpen their skills, ‘I think I’ve improved on my music a lot more because I had more time to practice’ (P50, aged 13–17). Some quoted reduced academic pressure or being financially secure as facilitators for being able to learn new skills.

I haven’t needed to worry about doing a job so I have money next month . So in a way , I’ve been able to relax a bit which has been really nice and not focused everything on my work . So that is where I’ve been able to dedicate time to help with anything outside and I actually produce video content for those and learn new skills when it comes to software … (P26, aged 18–24)

1 . 2 Opportunity to organise affairs . Some older adult participants described having the opportunity to catch up on overdue tasks in their personal life including home fixes and ‘sort(ing) out paperwork’ for their finances and medical care concerning their end of life.

It (the pandemic)’s given me the focus to get into the garden and get on with that because for seven years I was at best maintaining it . Last year I made a big effort to get on top of it . …and the lockdown has enabled me to get on with that . (P06, aged 70–74)

Both young and older people found opportunities to incorporate time for more wellness activities in their life as they began to value their health and well-being more.

I suppose kind of a sense of satisfaction that it’s giving me the space to finally get around to fixing certain aspects of my life . Sorting out routines and getting finally around to doing the exercise… meditating , the sort of general wellness personal admin stuff . I’m glad that’s happened … (P56, aged 18–24)

2 Increased sense of social cohesion .

2.1 Heightened compassion and connectedness . More than half of participants reported feeling closer to family and friends as a result of more frequent or consistent contact, given a ‘greater spirit of loneliness’ and heightened sense of compassion for others. Many young and older participants discussed the desire to be more intentional about strengthening or rekindling relationships into the future; ‘So , it’s going to be worth making more of in the future , making more effort about in the future . Family , it makes me realise that I do really love them and miss them . ’ (P07, aged 70–74)

Among young participants, some described increased closeness through consolidated friendship networks as ‘it (the pandemic) was like a friends filter’ (P27, aged 18–24); ‘There are some people I haven’t necessarily missed not seeing them .… I’ve connected with the people I’ve needed to . So , in a way my network it’s become clearer and seems closer . ’ (P37, aged 18–24)

2.2 Greater sense of community . With the shared experience of going through a pandemic, many participants described a greater sense of community, especially during the first national lockdown; ‘ During the initial bits of lockdown , there was quite this sense of solidarity , wasn’t it ? This general feeling of… this sucks , but we’re all in this together . …That was really nice . ’ (P39, aged 18–24)

Several young and older participants discussed a greater sense of belonging through the “Clap for Carers” (a social movement in appreciation of people working for the UK’s National Health Service) and increased interactions with neighbours; ‘We relate a bit more to the local neighbours . … They all come out and clap every Thursday night at 8 o’clock… So , chatting more to the neighbours is probably the main positive . ’ (P13, aged 80–84)

3 Greater personal growth .

3.1 New outlook on gratitude . Several young and older participants described a new outlook on gratitude, as they had come to ‘appreciate all the smaller things’ in view of restrictions that were imposed during the pandemic, including greater appreciation for outdoor activities, use of digital tools to keep in touch with friends and family, and favourable living conditions (i.e., having a garden). Several older participants described feeling fortunate to be retired and financially secure in comparison to many younger, working adults who may be struggling with job security during the pandemic.

We’re retired so we have our pensions , so we’re not having to worry about losing our jobs , losing our income or finding a way in which to work in order to be able to earn some money when there can’t be any contact between people . So I feel very fortunate that we’re not faced with that problem . (P03, aged 70–74)

Among young participants, many discussed a greater sense of gratitude towards their existing friendships or romantic relationships, given the challenges faced with meeting new people during the pandemic.

I think one of the downsides of the pandemic was meeting new people wasn’t really possible . And one thing I was really grateful for was that I am in a happy relationship with someone for the past two years . But some friends of mine who were single were struggling with this idea of trying to meet new people to date . …that made me very grateful that I do have a partner and three different people in my household I can rely on . (P27, aged 18–24)

3.2 Increased feelings of resilience . Having navigated the unexpected challenges of the pandemic, some young and old participants found that they felt more resilient; ‘I think I’m stronger than I thought I was , and that I can do things , possibly , I didn’t think I would be able to do , and I’ve coped better than I thought I’d be able to cope . ’ (P08, aged 70–74). Some young participants reported having gained the ability to take better care of themselves, thereby feeling more prepared to face future hardships; ‘I now know how important it is to have good mental health , constantly . So , that if anything like this were to happen again , I would be prepared . ’ (P51, aged 13–17) Some participants with physical or mental health conditions discussed feeling proud of their capacity to manage their condition amidst the challenges of the pandemic.

I’m probably proud of myself , how I’ve dealt with it (a heart attack) … Sort of managing my own symptoms , managing my own time , and in a way , being strong enough to say , I’m going to go to bed today . Rather than doing the socially acceptable thing of pushing myself … So , I’m quite proud of myself that I’ve been able to do that . (P65, aged 70–74)

Helpful coping behaviours

4 use of problem-focused strategies to manage pandemic-related pressures..

4 . 1 Managing intake of pandemic-related news . Given the changing circumstances during the pandemic, some participants (both younger and older) acknowledged that ‘cutting down on news bulletins but nevertheless , making sure that one is in touch with what is happening , is probably advantageous’ (P04, aged 85–90). Some found it helpful to intentionally minimise consumption of news in view of adverse impacts on their mental health; ‘whenever I read the news it’s always just bad things . It always makes me worry , so just staying away from that helped as well . ’ (P50, aged 13–17)

4 . 2 Adopting a new routine . As the pandemic resulted in restrictions to usual activities, participants reported having to adapt their lifestyle to ‘a socially distant world’ . Around one-third of young participants described how adopting a new routine during the pandemic afforded a sense of structure and helped them feel ‘more under control’ , mitigating the potentially negative impact of remote studying/working from home which blurred study/work-life boundaries; ‘ I think the important things to me over lockdown have been actually to give myself a bit of a schedule and wake up by around 7 : 00 , 7 : 30 in the weekdays than actually have a lie-in . ’ (P26, aged 18–24). Furthermore, some discussed how online platforms facilitated self-paced learning which afforded better flexibility and ability to sustain a routine.

Some older adult participants described a new sense of purpose and achievement in keeping up a routine as similar as possible to that of pre-pandemic times while allowing themselves the flexibility to ‘swap things around’ .

I do make myself behave as if , yes , I’m going out to do something . Even if it’s only to go for a walk , or do the garden , that is my thing and I’m going to do it properly . … and I feel , therefore , positive that I have done things , and achieved things . (P08, aged 70–74)

5 Use of strategies to regulate thoughts and emotions.

5 . 1 Engaging with online arts and digital mental health apps . Many participants, especially older adults, missed engaging with arts and cultural activities in-person but most found it helpful being able to continually engage in such activities from home through virtual means during the pandemic. Participants reported that engaging in arts activities such as watching performances online or via television, participating in a “Zoom choir” and listening to music helped soothe feelings of anxiety or worry and elicited positive emotions.

And from Sky Arts on my big TV that has a few programmes a week . …compared with how often I might have been going to the theatre or cinema . I’ve been able to get performances there . It’s kept me happy . (P11, aged 70–74)

Several young people reported worries about uncertainty of their studies and future career; however, digital mental health apps assuaged some of these feelings by helping them to become more aware of strategies to improve their mental health.

I now have a mood tracking app (MindDoc) on my phone …so that I can track my mood and see what it affects . …it can give you very personalised advice . So that’s something I’ve taken up which I think I’m going to keep doing , because I think it’s very helpful . (P61, aged 13–17)

5 . 2 Being outdoors and connecting with nature . The majority of participants reported heeding government guidance that allowed outdoor exercise during lockdown and found it helpful to get ‘fresh air’ outdoors, with several describing easy access to green spaces as a facilitator for these coping behaviours. Some young participants spoke about how getting out helped them unwind after a long day of working or studying from home; ‘I did go out for the once-a-day exercise . I usually tried to do it after work just to give me that break to change my mindset from work mode to coming back to relaxing . ’ (P36, aged 18–24)

While the pandemic seemingly brought everyday life to a standstill, several participants, young and old, found it ‘therapeutic’ connecting with nature, where some participants described that seeing plants grow symbolised a sense of time passing.

Having plants grow within the house is an amazing way to keep track of time when it all seems so monotonous because it changes , it grows , and you are there . It’s a little project and I found that it’s so fantastic for me . I’ve really loved having my plants . (P26, aged 18–24)

6 Giving and receiving social and community support.

6 . 1 Engaging with interest-based social groups . Many participants found it rewarding to engage in interest-based social activities. Among these participants, several older adults reported engaging in groups such as walking groups, online writing groups or photography groups to keep their mind and/or body active while maintaining social connections.

Oh , and the other one I’m sort of involved , I was before lockdown , in a creative writing group… we’ve been doing that on Zoom .… . So that’s as a little social thing and keeping the mind active as well . Keep that going , yes . (P22, aged 75–79)

Amongst young participants, many described how engaging in online multiplayer games strengthened their relationships with friends or expanded their social circle as such games facilitated ‘friendly competition’ and allowed them to enter into a lot of discussions; ‘Since lockdown started , I’ve been involved in playing a lot more social board games online…and really built a wonderful community of people from all around the world who are really interesting people . …It’s a nice , different tangent . ’ (P26, aged 18–24)

6.2 Volunteering and community participation.

Several young participants sought out in-person volunteering, such as with foodbanks and delivering essentials to people who are shielding, as ‘another excuse to get out of the house’ (P57, 18–24) while also feeling helpful and needed.

The only thing that I wasn’t doing that was fully rigid with the routine of lockdown was volunteering at the foodbank . And that was because I thought I would just absolutely go crazy if I had to stay in the house the whole time… I just genuinely feel like everything that I do at the moment is really worthwhile to someone , it’s always helping someone else in some way … (P40, aged 18–24)

Among older adult participants, some discussed finding a sense of usefulness while keeping their mind busy by participating in surveys/studies.

My way of doing my bit … is participating in studies like yours… because I can’t go out there and deliver meals to people… but what I can do is contribute to a body of knowledge , that hopefully will be helpful to people in the future . (P18, aged 70–74)

In this qualitative study, we investigated positive psychological experiences and helpful coping behaviours perceived by young people and older adults in the UK in the first year of the COVID-19 pandemic. There were many similarities in the broad types of psychological experiences that younger and older adults had, as well as similarities in the broad coping behaviours employed, although the details of how these experiences and behaviours were perceived and enacted varied by age. Nonetheless, we identified several common potential components of future interventions to support both young people and older adults in times of pandemics, including activities that foster a sense of community and connectedness (such as “Clap for Carers”), resources that support a stable routine (such as self-paced online learning) and platforms that offer digital means of engaging with hobbies (either on the internet or via mobile phone apps).

One of our salient findings was an increased sense of social cohesion across age groups, congruent with evidence indicating greater gestures of solidarity [ 16 ] and the heightened value of personal relationships during the COVID-19 pandemic [ 14 ], which reinforce the value of platforms that foster these activities to take place. Our results build on previous research by suggesting how a heightened sense of loneliness and engaging in collective action may encourage a greater community spirit across the age groups amidst social distancing restrictions. While it has been suggested that many young people suffered from loss of social connections during the pandemic [ 29 ], a novel finding from our study is that some young participants acknowledged how social restrictions have inadvertently weakened some social ties yet strengthened other key friendships, which facilitated a sense of increased relational closeness. Results suggest that many participants felt that their social networks evolved towards strengthened relationships and stronger community ties, which in turn, improved perceptions of overall well-being.

Several pandemic-related experiences reported by participants appeared to be shaped by their different life stages (i.e., young versus older adulthood) and these factors further shaped subsequent coping behaviours. For instance, younger participants highlighted reduced academic pressure or being financially secure as enablers to exploring new skills. Emerging evidence suggests that younger people, as compared to older adults, had more financial worries during the pandemic [ 43 ] and having financial support has been shown to be a protective factor for coping among young people [ 44 ] –hence there is additional need for financial and occupational support toward young people in the future, coming out of the pandemic. The protective role of financial security also resonated with some older participants who described feeling grateful to be retired and financially secure compared with other groups. Moreover, many participants across both age groups discussed a greater sense of appreciation for smaller things in life during the pandemic, reflecting a sense of gratitude which can encourage psychological resilience [ 45 ]. Furthermore, our finding that some participants felt a greater sense of resilience within themselves supports the argument that adverse circumstances of living (such as those present during the COVID-19 pandemic) may encourage personal growth and resilience [ 46 ]. Our results expand previous findings of personal growth among young people during the pandemic [ 47 ] by suggesting that young participants experienced personal growth from having recognised and developed their ability to protect their own mental health in the future.

With regards to helpful coping behaviours, we noted some similarities and differences across age groups. Several young and older participants expressed mental health benefits of engaging in arts and cultural activities remotely, consistent with existing evidence for the use of arts to help cope with emotional experiences during the pandemic [ 48 ]. Our results further suggest how increasing digital access to arts during the pandemic is especially valuable to older adults who may otherwise be less likely to engage in arts through digital means as compared to young people. Among young people, our results on the use of digital mental health apps in supporting mental health highlights the promise of such tools in equipping individuals with self-care skills in the future [ 49 ]. Evidence suggests that engaging with nature is linked with more positive emotions and fewer symptoms of anxiety, particularly amid stringent lockdown measures during the pandemic [ 50 ]. We found that the main differences in this and with several other coping behaviours between young and older age groups were attributed to work-related stress. For instance, some young participants specifically highlighted how spending time outdoors helped them de-stress while adapting to remote working and learning during the pandemic. This could be taken into account by employers and education providers in the event of future social distancing restrictions.

In view of evidence which suggests increased volunteering behaviours in the UK during the COVID-19 pandemic [ 51 ], our findings highlight potential age differences in one aspect of volunteering whereby in-person volunteering was especially prominent among young participants. Erikson’s stage theory of psychosocial development [ 52 ] posits that adolescent years present a conflict of identity versus role confusion whereby adolescents navigate their independence and develop a sense of self. In-person volunteering may have facilitated such aspects of growth as young participants described gaining a sense of being useful while escaping the confines of home during the pandemic. Additionally, young people may have been less worried about their risks from COVID-19 when compared with older adults [ 53 ], hence readily sought out in-person volunteering opportunities. Furthermore, a novel finding of our study is that some older adult participants found it beneficial for their wellbeing to volunteer for research surveys during the pandemic, highlighting how volunteering opportunities must be accessible to all age groups. This extends existing literature that being useful in this manner could add meaning to individuals’ lives [ 54 ], by potentially helping people to make sense of life during the pandemic.

Strengths and limitations

This is the first known study that qualitatively explored positive psychological experiences and helpful coping behaviours perceived by young people and older adults in the UK during the COVID-19 pandemic. Purposive sampling enabled greater demographic diversity among participants, which facilitated rich nuances about the experiences of participants that could be targeted in future public health interventions. However, the socioeconomic background of participants was not known, and this may have biased certain findings. While in the present study (where participants were predominantly White British) we found a greater sense of community, some studies indicated reduced sense of social cohesion among some ethnic minority groups in the UK, as the pandemic had more adverse impacts in these communities [ 55 ]. Our data collection period may also have influenced the results of our study, given that interviews concluded in January 2021, less than one year since the start of the pandemic as declared by the WHO [ 56 ] –hence young and older adults’ experiences may be different at later stages of the pandemic. Moreover, the sample may be biased towards people who were less severely impacted by adversities during the pandemic or coping better than others who were unable to participate. Therefore, we cannot assume the transferability of our results to all other contexts and the coping behaviours may not reflect that of the broader population of older or young people.

Implications

This study highlights some key implications for coping during a pandemic and beyond. First, digital mental health apps may be a valuable tool to support mental health during crisis situations where access to formal mental health support is limited, therefore, further research on their potential is warranted. Second, the benefits of spending time outdoors and connecting with nature may have policy implications for access to green spaces during the pandemic as well as implications for green social prescribing to support well-being [ 57 ]. Third, present findings on positive psychological experiences and coping behaviours that protect well-being suggest scope for an extended version of the PERMA model of positive psychology: PERMA-H model [ 58 ], which incorporates the facet of positive health. Our findings support the idea that a positive psychology model that includes physical and psychological health may be especially relevant in the context of an infectious disease pandemic to understand well-being more holistically. Moreover, further research is warranted to understand the experience of various socioeconomic groups and ethnic backgrounds and capture experiences over time given the fluctuating nature of the pandemic.

Conclusions

While the COVID-19 pandemic has presented many challenges in various aspects of life of young people and older adults, participants’ use of various coping strategies reflect their resilience. In brief, participants described coping behaviours that protect their well-being, with older participants adapting lifestyles in the context of worries about their vulnerability to COVID-19. Moreover, this study highlights positive psychological experiences during the pandemic such as heightened connectedness and increased feelings of resilience. While all six themes were relevant both to younger and older adults, there were nuances in the experience and enactment of behaviours between each age group. These findings may be useful to guide tailored support for well-being among young and older age groups during a pandemic and post-pandemic recovery.

Supporting information

S1 fig. interview topic guide..

https://doi.org/10.1371/journal.pone.0279205.s001

S2 Fig. Interview guide example questions and prompts pertinent to the research question.

https://doi.org/10.1371/journal.pone.0279205.s002

S1 Table. Timeline of COVID-19 restrictions in UK between 2020 and 2021 and proportion of study interviews conducted in each month.

https://doi.org/10.1371/journal.pone.0279205.s003

S2 Table. Minimal data set.

https://doi.org/10.1371/journal.pone.0279205.s004

Acknowledgments

The researchers are grateful for the support of AgeUK, Alzheimer’s Society, Healthwise Wales and British Youth Music Theatre during recruitment. We are grateful to Anna Roberts, Joanna Dawes, Louise Baxter, Sara Esser, Rana Conway and Tom May for their help with conducting interviews. The authors extend thanks to study participants for their valuable contributions.

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Advancing the Study of Positive Psychology: The Use of a Multifaceted Structure of Mindfulness for Development

Huy p. phan.

1 School of Education, University of New England, Armidale, NSW, Australia

2 Department of Education, National Taipei University of Education, Taipei, Taiwan

3 Graduate Institute of Asian Humanities, Huafan University, New Taipei City, Taiwan

Bing H. Ngu

Si chi chen, sheng-ying shi, ruey-yih lin.

4 Department of Industrial Engineering and Management Information, Huafan University, New Taipei City, Taiwan

Jen-Hwa Shih

5 Department of Buddhist Studies, Huafan University, New Taipei City, Taiwan

Hui-Wen Wang

6 Department of Asian Philosophy and Eastern Studies, Huafan University, New Taipei City, Taiwan

Positive psychology, as a distinctive paradigm, focuses on the remedy of pathologies and, by contrast, the promotion of positive experiences and conditions in life (e.g., encouraging a state of flourishing). Positive psychology, in its simplistic form, may provide evidence and insightful understanding into the proactivity of human agency ( Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ). Drawing from this emphasis, we have developed the theory of optimization , which attempts to explain the achievement of optimal functioning in life (e.g., optimal cognitive functioning: academic performance). By the same token, in the course of our research development into the theory of optimization, we have also delved into a comparable theoretical orientation, namely: the multifaceted nature of mindfulness , consisting of three interrelated components – the psychological component of mindfulness, the philosophical component of mindfulness, and the spiritual component of mindfulness. This conceptualization of mindfulness is rather unique for its incorporation of both Western and Eastern knowledge, philosophical viewpoints, and epistemologies into one holistic framework. The main premise of this conceptual analysis article is to advance the study of positive psychology by specifically introducing our recently developed model of mindfulness, in this case, the multifaceted structure of mindfulness with its three distinct components. Importantly, we make attempts to highlight the significance of this multifaceted model by situating it within the theory of optimization for academic learning. Using philosophical psychology and personal-based teaching and research reasoning, we provide a valid rationale as to how aspects of our proposed model of mindfulness (e.g., reaching a state of enlightenment) could act to facilitate and optimize a person’s state of functioning (e.g., cognitive functioning). Moreover, we posit that our rationale regarding mindfulness as a potential “optimizing agent” for the purpose of optimal functioning could, indeed, emphasize and reflect the salient nature of positive psychology. In other words, we contend that an explanatory account of mindfulness from the perspectives of Confucianism and Buddhism could, in this analysis, coincide with and support the meaningful understanding and appreciation for the study of positive psychology in educational and non-educational contexts. We conclude the article by exploring the complex issue of methodology – that is, for example, how would a researcher measure, assess, and/or empirically validate the multifaceted nature of mindfulness?

Introduction

The present article makes attempts to accentuate the important nature of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ) by taking into account and incorporating the theoretical concept of mindfulness. In other words, our main premise is to introduce preliminary details of our recently developed theoretical model of mindfulness ( Phan and Ngu, 2019 ; Phan et al., 2019d ), which could hopefully instill appreciation and facilitate meaningful understanding into the paradigm of positive psychology. This theoretical-conceptual article emphasizes the use of philosophical psychology and personal reasoning to rationalize the potential intricate association between mindfulness and positive psychology . We contend that our proposed model of mindfulness is innovative and, indeed, espouses notable tenets of Buddhism (e.g., enlightenment) that may, in effect, advance understanding into the true nature of positive psychology.

In the next section of this article, we provide an overview of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ), which is then followed by a brief theoretical account of the theory of optimization ( Fraillon, 2004 ; Phan et al., 2017 , 2019c ) and its association with the concept of optimal best practice ( Fraillon, 2004 ; Martin, 2006 , 2011 ; Phan et al., 2016 ). This overview in the initial stage is beneficial, forming grounding for the subsequent sections of the article – namely, an examination of the theoretical concept of mindfulness. In the latter section of the article, we offer a conceptualization, which researchers may consider for their own inquiries. One notable line of inquiry, in this case, is related to the development of an appropriate methodological design that could measure, assess, and validate our proposed model of mindfulness.

The Importance of Positive Psychology: a Brief Overview

There has been extensive research development pertaining to the nature of positive psychology. Why study positive psychology? Positive psychology, emerging within the field of psychology as a paradigm for quality teaching and scientific research development ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ), lies in its nature to address and prevent pathologies and maladaptive experiences. Moreover, positive psychology, spanning the course of three decades, is concerned with the encouragement and promotion of positive experiences and conditions in life ( Pawelski, 2016 ). Indeed, according to Gable and Haidt (2005) , the study of positive psychology considers different internal and external conditions that could contribute to a person’s and/or an organization’s state of optimal functioning.

So, what is positive psychology? According to Sheldon et al. (2000) , positive psychology:

“Positive Psychology is the scientific study of optimal human functioning. It aims to discover and promote the factors that allow individuals and communities to thrive. The positive psychology movement represents a new commitment on the part of research psychologists to focus attention upon the resources of psychological health, thereby going beyond prior emphases upon disease and disorder” (section “The Importance of Positive Psychology: A Brief Overview”).

This definition, as reflected in Pawelski’s (2016) comprehensive review of this topic, connotes the inclusion of attributes such as personal growth, mastery, drive, character building, human strength, and family and civic virtue. From this emphasis, the study of positive psychology may entail the “building of the most positive qualities of an individual” ( Seligman, 1999 ) and “on building of what makes life most worth living” ( Seligman, 1999 ). Seligman and Csíkszentmihályi’s (2000) published work, likewise, emphasizes the science of positive psychology may exist on three levels – subjective, individually, and institutional: “the field of positive psychology at the subjective level is about valued subjective experiences: well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present). At the individual level, it is about positive individual traits: the capacity for love and vocation, courage, inter-personal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom. At the group level, it is about the civic virtues and the institutions that move individuals toward better citizenship: responsibility, nurturance, altruism, civility, moderation, tolerance, and work ethic” (p. 5).

From the above, positive psychology is well-balanced in scope delving into the resolution of the spectrum of both negative and positive life experiences ( Pawelski, 2016 ) – that is, flourishing at one end of the continuum (i.e., positive) and languishing at the other (i.e., negative) ( Keyes, 2005 ). In terms of the proactivity of human agency ( Phan et al., 2020a ), incorporation of positive psychology may involve the fostering of optimal functioning. In this analysis, deep meaningful understanding of positive psychology acknowledges the entirety of human experiences with the hope that we could facilitate, motivate, and enhance optimal conditions for the purpose of self-fulfillment and flourishing. This tenet reflects importantly, from our viewpoint, the maximization of a state of condition or functioning – that is, the notion of optimal condition or functioning in a subject matter or contextual setting.

Recent research development using positive psychology as a main premise has explored an interesting topic, known as optimal functioning ( Martin, 2011 ; Liem et al., 2012 ; Phan et al., 2016 ). Optimal functioning, or optimal best practice, is concerned with the maximization of a person’s acquired knowledge, experience, and/or personal state of flourishing in a subject matter (e.g., feeling good about oneself) ( Ngu et al., 2019 ). Over the past 5 years, we have made extensive theoretical, methodological, and empirical contributions to the study of optimal best practice, especially within the realm of academia (e.g., Ngu et al., 2019 ; Phan et al., 2019b , 2020b ).

The Importance of Optimal Best Practice

Optimal best practice is an important topical theme for discussion as it reflects the nature of positive psychology. In brief, from the preceding section, we know that optimal best practice is concerned with the maximization of fulfillment and/or accomplishment – say, in mathematics learning in the topic of Algebra. At the same time, however, achievement of optimal best is indicative of positive psychology, especially in terms of personal experience of fulfillment and inner satisfaction. What is of interest from this understanding, as initially raised by Fraillon (2004) , is the methodological account or explanation of how optimal best is calculated or derived. This examination, which we have explored in-depth, is insightful in helping to elucidate the positive nature of positive psychology.

The concept of optimal best practice is significant, especially in light of our focus on the use of mindfulness to appreciate the nature of positive psychology. Fraillon (2004) and Phan and his colleagues (e.g., Phan et al., 2016 , 2017 ) have been prominent in their respective discussions regarding the operational nature of optimal best practice – that is, for example, how does one achieve a state of optimal best practice in a subject matter? According to the authors’ explanations, achievement of optimal best practice requires a point of reference or, alternatively, optimal best practice is intricately linked to a reference point. Phan et al.’s (2019b) recent article is insightful for its detailed account, which we refer in this section. Figure 1 is a summary of the process of optimization ( Phan et al., 2017 , 2019c ), which shows two levels of best practice:

Simplistic representation of process of optimization.

• i. A level of current best practice , denoted as L 1 , according to Fraillon (2004) and Phan et al. (2019c) , is defined as a person’s perceived level of functioning at the present time – for example, “what is it that I am capable of at present in Algebra?” (e.g., I am able to solve equations with one unknown, x , at present).
• ii. A level of optimal best practice , denoted as L 2 , in contrast, is defined as a person’s perceived maximum level of functioning that could be fulfilled and/or accomplished ( Fraillon, 2004 ; Phan et al., 2019c ) – for example, “I perceive and believe that I am capable of accomplishing….. in Algebra” (e.g., I am capable of solving equations with two unknowns, x and y . This accomplishment is my maximum capability).

The relationship between L 1 and L 2, in its simplistic term, according to Phan et al.’s (2019b) recent study, is shown in Figure 1 . The uniqueness of Figure 1 lies in the concise representation of the enactment of optimization ( Phan et al., 2017 , 2019c ), and a “state of flourishing” – in this case, defined as “a quantitative and qualitative difference between L 1 and L 2 [i.e., Δ (L1–L2) ].” The theory of optimization ( Phan et al., 2019c , 2020b ) indicates that the achievement of L 2 from L 1 would require the activation and enactment of different types of educational (e.g., an appropriate instructional design: Ngu et al., 2018 ), psychological (e.g., belief of personal efficacy: Bandura, 1997 ), and psychosocial (e.g., the impact of the home environment: McCartney et al., 2007 ) agencies. Phan et al.’s (2019c) detailed proposition, interestingly, stipulated the positive effects of educational, psychological, and/or psychosocial agencies on the initiation of experience of “energy” (denoted as “E”), which would then activate the buoyancy of different psychological attributes (e.g., personal resolve). Buoyant psychological experiences, in turn, would arouse and sustain the accomplishment of L 2 .

Optimal best practice, L 2 , may entail different types of functioning – for example, cognitive functioning in a school context may reflect exceptional exceptional academic performance in essay composition. Optimal best practice in emotional development, likewise, may consist of a person’s state of happiness. Aside from the importance of optimal best practice, poignant from Figure 1 also is the description that pertains to a person’s state of flourishing – denoted as Δ (L2–L1) . Flourishing in this case, similar to other comparable definitions (e.g., Diener et al., 2010 ; Huppert and So, 2013 ), is positive and reflects improvement, accomplishment, and self-fulfillment. From Phan et al.’s (2019c) theory of optimization, there are three main premises for acknowledgment:

• i. A focus on the facilitation of L 2 , via means of different types of optimizing agents (e.g., educational agent such as an appropriate instructional design: Ngu et al., 2016 ).
• ii. A focus on ensuring that a person experiences a state of flourishing, which would equate to a positive difference between L 1 and L 2 .
• iii. The underlying role of energy, which is central to the process of optimization, facilitating a person’s improvement and progress from L 1 to L 2 .

From the preceding sections, one notable aspect of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ) is concerned with the accomplishment and fulfillment of optimal conditions and life experiences (e.g., feel-good experience). Since the emergence of positive psychology, there have been different theoretical models developed to help foster the accomplishment and fulfillment of optimal best practice – emotionally, socially, cognitively, physically, and socially. By the same token, of course, constructive models reflecting the importance of positive psychology have also focused on preventive measures, which could resolve and weaken negative life experiences, pathologies, etc. From the literature, for example, there are some interesting models: Seligman’s (2010) PERMA model (i.e., Positive Emotions, Engagement, Relationship, Meaning, and Accomplishment), Csíkszentmihályi’s (1990) flow theory , Keye’s (2002) continuum of psychological wellbeing , Peterson and Seligman’s (2004) Character Strengths and Virtues Framework , and Phan et al.’s (2017) Framework of Achievement Bests .

Indeed, from a practical point of view, not to mention theoretically, there is impetus for us to consider research development, policies, programs, pedagogical practices, etc. that may assist in the fostering of flourishing. Within the context of schooling, as an example, it is pertinent that educators consider different opportunities, pathways, means, etc. that may assist students in their learning (e.g., mastery experience in a subject matter) and non-learning (e.g., psychological well-being) experiences. In a recent study, for example, Phan et al. (2019a) found that social relationships with others (e.g., peers) and enriched academic experiences may serve to enhance positive emotions. In another similar study, Hasnain et al. (2014) reported that both hope and happiness positively influenced students’ psychological well-being. Tugade and Fredrickson (2007) , interestingly, offered a number of strategies that could be considered for usage (e.g., relaxation therapies and meditation practices).

Introducing the Importance of Mindfulness

Phan et al.’s (2020b) recent article is significant as it introduces the concept of time ( Frank, 1939 ; Lewin, 1942 ; Wallace, 1956 ; Nuttin, 1964 ; Mehta et al., 1972 ) and its potential association with the achievement and fulfillment of L 2 . In this analysis, Phan et al. (2020b) contend that in order for one to achieve a state of flourishing, Δ (L2–L1) , he/she would need to structure and have an appropriate future time point (e.g., 6 months). In other words, from the authors’ rationale, achievement of L 2 from L 1 does not occur instantaneously but requires adequate time. By the same token, this rationalization also considers the plausibility that a future time orientation may, in itself, serve as a source of motivation, which would direct and compel a person to strive for optimal best. This rationalization is interesting, highlighting the complexity of the fulfillment of L 2 .

Considering Phan et al.’s (2020b) rationalization of time, we consider another related concept, which could serve to facilitate the achievement of optimal best practice: mindfulness . What is so unique about mindfulness and why would we would want to include this concept for in-depth examination, especially with reference to the study of positive psychology? There are three major reasons:

• i. Our individual and collective interests in mindfulness from an Eastern perspective, which in this case encompasses both Confucianist thinking and Buddhist philosophy. We contend that this article is appropriate, allowing us to introduce our proposition of a theoretical model of mindfulness ( Phan and Ngu, 2019 ; Phan et al., 2019d ) for readers to appreciate.
• ii. Mindfulness is personal and proactive, coinciding with and reflecting the true nature of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ). For example, meaningful understanding of mindfulness may assist a person to feel “enlightened,” resulting in the fulfillment of happiness.
• iii. We contend that it would be of interest to consider mindfulness, via means of meditation practice as an optimizing agent, as Phan et al. (2019d) recently discussed in their theoretical-conceptual chapter. In this analysis, as a proposition, we posit that our derived model of mindfulness could optimize a person’s state of functioning.

In this section of the article, we want to explore the definition(s) and scope of mindfulness from a psychological point of view. The latter sections of the manuscript introduce our recently developed model of mindfulness ( Phan and Ngu, 2019 ; Phan et al., 2019d ), and how this theorization could indeed explain the specific reference to optimal best practice – in this case, the use of optimization, as an underlying process, to explain for the achievement of L 2 .

Definition and Scope of Mindfulness and Meditation

Scientific research into the concept of mindfulness is well documented in different journals (e.g., the journal of Mindfulness ). One important line of research development, in this case, focuses on clarity into the definition and nature of mindfulness. Aside from definition, the “nature” of mindfulness connotes understanding of its scope and underlying structure – that is, what constitutes the “essence” of mindfulness? This question, we contend, reflects a similar theoretical approach to the study of other psychological concepts, such as self-efficacy ( Bandura, 1977 , 1997 ), self-concept ( Shavelson et al., 1976 ; Marsh et al., 1988 ), and engagement ( Schaufeli et al., 2002 ; Fredricks et al., 2004 ).

There are a number of comparable definitions of mindfulness. For example, Kabat-Zinn (2015) defines mindfulness as “moment-to-moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively, as non-judgmentally, and as openheartedly as possible.” Desbordes et al. (2015) , differently, makes reference to mindfulness as “the quality of mind that one recollects continuously without forgetfulness or distraction while maintaining attention on a particular [mental] object.” Brown and Ryan (2003) , acknowledging Buddhist and contemplative traditions and other researchers’ theoretical contributions, define mindfulness as “a state of being attentive to and aware of what is taking place in the present.” This definition, as the authors noted, reflects both Nyanaponika Thera (1972) (i.e., “the clear and single-minded awareness of what actually happens to us and in us at the successive moments of perception,” p. 5) and Hanh’s (1976) definition of mindfulness (i.e., “keeping one’s consciousness alive to the present reality,” p. 11). From our own teaching, coinciding with Buddhist philosophies and the importance of Confucianism, we surmise mindfulness as being of the following: a person’s state of: (i) awareness of the present moment , (ii) consciousness and focus of his/her contextual surrounding , and (iii) concentration of a designated object in mind (e.g., image of Buddha) .

What actually defines mindfulness, as detailed from the above, in turn reflects the importance of the concept’s nature – that is, its scope and underlying structure. From an empirical point of view, researchers have used a quantitative methodological approach ( Hanson et al., 2005 ; Babbie, 2014 ), involving both experimental and non-experimental data to study the true nature of mindfulness. For example, non-experimentally, researchers have used factorial techniques to test and compare competing a priori and a posteriori model ( Schumacker and Lomax, 2004 ; Kline, 2011 ) – does a one-factor model, in this instance, represent the underlying structure of mindfulness? Or, comparatively, does a two-factor model provide a stronger representation of mindfulness? From the literature, we see that numerous questionnaires (e.g., The Toronto Mindfulness Scale; Lau et al., 2006 ) have been developed to measure and assess the construct of mindfulness. Table 1 illustrates a brief summation of existing research that has used both open-ended and close-ended questionnaires to gauge into the nature and predictive effect of mindfulness. It is interesting to note that there is no definitive consensus as to what actually constitutes mindfulness. Some researchers, for example, have established a simple structure: a one-factor (e.g., Brown and Ryan, 2003 ; Chadwick et al., 2008 ) and a two-factor (e.g., Cardaciotto et al., 2008 ; Davis et al., 2009 ) model. In contrast, too, other researchers tested and established more complex models: a four-factor (e.g., Baer et al., 2004 ; Feldman et al., 2007 ), a five-factor ( Baer et al., 2006 ), and a six-factor ( Neff, 2003 ) model.

Mindfulness scales and inventories.

It is indeed interesting to note the differing viewpoints and interpretations of mindfulness. Our own proposition, likewise, also adds credence, providing another comprehensive interpretation of the nature of mindfulness. Despite the complexity of viewpoints and interpretations and the quest for us to add theoretical contributions, we can surmise that mindfulness is purposive and meaningful , reflecting a person’s temperament, personality and, more importantly, his/her state of mind. This theoretical positioning of mindfulness, as concurred by Western scholars (e.g., Chiesa et al., 2011 ; Keng et al., 2011 ; Treanor, 2011 ; Bowlin and Baer, 2012 ; Hjeltnes et al., 2015 ), emphasizes two fundamental tenets:

• i. A person’s experience of a present state , reflecting clear focus and personal contentment, may serve to instill an internal state of calmness, ease, and clarity.
• ii. Experience of mindfulness, in its truest sense, may yield a number of meaningful outcomes , such as improvement in positive emotions (e.g., happiness) and personal functioning (e.g., performance in a subject matter), and weakening in negative emotions (e.g., anxiety).

In essence, the study of mindfulness has involved scholars from the United States, the United Kingdom, Europe, Australia, etc. (e.g., Baer et al., 2008 ; Sauer et al., 2011 ; Kabat-Zinn, 2015 ). Despite this collective interest, we purport that inconsistency is still evident in terms of a common definition and understanding of mindfulness. Why is this the case? Despite the effectiveness and robustness of factorial techniques ( Schumacker and Lomax, 2004 ; Kline, 2011 ), it can be said that quantitative representations (e.g., a four-factor model) are somewhat limited and do not, in this case, provide comprehensive evidence of the nature of mindfulness. A factorial-derived mapping of mindfulness, from our point of view, is somewhat limited and too simplistic for interpretation and in-depth account of its structure. The crux of our argument then is that mindfulness encompasses much more than just a simple definition (e.g., say… a person’s psychological state of ease), which could simply espouse “a persons’ psychological state of ease,” or “a person’s experience of reflection and self-awareness.”

Interestingly, in the Western literature (e.g., a Google search), another terminology also coincides with the concept of mindfulness – namely, in this case, the concept of meditation , also known as meditation practice . So, from this introduction, what is meditation or meditation practice? From a general point of view, there are many different types of meditation practice – for example: breath-awareness meditation, visualization meditation, and mantra-based meditation 1 . From a more technical point of view, reflecting the importance of Buddhist teaching, Loden (1996) defines meditation as “thoroughly and deeply acquainting the mind with objects of virtue. Because virtuous minds are by nature happy and the source of future happiness, each time that you engage in meditation further happiness is brought into your life” (p. 23). In a similar vein, Olendzki (2009) considers meditation as being the “sustained consideration or thought upon a subject.… As such, it is always an exercise of ordered conceptual contemplation, involving the systematic and disciplined use of language, symbol, and concept” (p. 37). Kabat-Zinn (2015) likewise defines meditation as being “the systematic and intentional cultivation of mindful presence, and through it, of wisdom, compassion, and other qualities of mind and heart conducive to breaking free from the fetters of our own persistent blindness and delusions” (p. 1482). From this brief account, we could say that meditation practice (e.g., “seated meditation practice”) is intentional, enabling a person to seek positive experience of calmness, concentration, and emotional balance. In our own teaching of meditation practice at university, for example, we teach and engage students in a practice known as “walking meditation practice.” Students would, in this case, recite the Buddhist sutras as they “walk” in a straight line or in a circle, paying close attention to their breathing.

We advocate and contend, indeed, that both mindfulness and meditation practice are two interrelated, but distinct concepts. As practitioners and researchers of mindfulness from an Eastern perspective, we argue for the following interpretation: that meditation practice (e.g., walking meditation) acts a practical mechanism, which would then facilitate and enable the personal experience of mindfulness (e.g., reaching a state of self-actualization). In other words, differing from scholarly previous conceptualizations and interpretations, we align our deliberation with those established in Buddhist texts (e.g., “ Meditations on the path to enlightenment ”) ( Loden, 1996 ). From this consideration, we argue that meditation is an intentional applied personal practice whereas, in contrast, mindfulness is the acquired knowledge and experience that a person subsequently attains. From this stipulation, we argue that it is somewhat erroneous to make statements such as, “I’m practicing mindfulness right now…” and “I am experiencing meditation at the moment….” Supporting our theorization is another interesting terminology, coined as mindfulness meditation ( Kristeller, 2007 ; Tang et al., 2007 ; Bauer-Wu, 2010 ). What is mindfulness meditation? According to Kristeller (2007) , mindfulness meditation, also referred to as “Vipassana practice” and “insight meditation,” is primarily concerned with the cultivation of a person’s “ability to bring a non-judgmental sustained awareness to the object of attention rather than cultivating focused awareness of a single object, such as a word or mantra, as occurs in concentrative meditation. Mindfulness meditation may utilize any object of attention – whether an emotion, the breath, a physical feeling, an image, or an external object-such that there is more flexibility in the object of awareness than there is in concentrative meditation and such that the object may shift from moment to moment” (p. 393). We appreciate and concur with this viewpoint of mindfulness meditation as indeed, upon reflection, we teach and practise this personal approach. For us, in our teaching, mindfulness meditation may entail a focus on and the visualization of Buddha during our meditative practice.

Mindfulness meditation then, from this consideration, is a style of meditation ( Tang et al., 2007 ; Bauer-Wu, 2010 ), similar to that of concentration meditation, mantra meditation, and guided meditation. As a “mind control,” or a “training” technique, according to Kristeller (2007) , mindfulness meditation may assist in the facilitation of the achievement of “physical relaxation, emotional balance, behavioral regulation, and changes in self-judgment, self-awareness, and relationship to others” (p. 395). As we discuss later in the article, mindfulness meditation is quite appropriate and potent, coinciding with the teaching of Buddhism and Confucianism – in other words, as we attest, mindfulness meditation is an applied practice, which may result in the achievement in understanding and experience of mindfulness.

Contemporary Understanding and Research Development: Introduction of Proposition

At present, from our synthesis and review of the literature (e.g., Baer et al., 2008 ; Sauer et al., 2011 ; Kabat-Zinn, 2015 ), mindfulness is analogous to that of a person’s meditational state . From a practitioner’s point of view, mindfulness is concerned with an internal state of “calmness,” “ease,” and/or “relaxation.” By the same token, mindfulness is not concerned with a person’s ability or inability to be “mindful” of a situation and/or an event – for example, statements such as “I am mindful that we are late for our next appointment” and “I need to be mindful that his grandfather recently passed away” may, in this sense, reflect a person’s cognizance and/or attentiveness of a contextual situation. This consciousness does not, in our view, equate to meaningful understanding and/or experience of mindfulness. Mindfulness is more than just attentiveness and may delve into other complex facets. In this analysis, as we have argued, it is somewhat limited to perceive and interpret mindfulness as simply a psychological state of attentiveness, reflection, self-awareness, etc.

Research development in the area of mindfulness is evolving and ongoing. One notable line of inquiry is, of course, concerned with theoretical, methodological, and empirical contributions to the elucidation and understanding of the nature of mindfulness. Ultimately, what is mindfulness and how does one perceive this on a daily basis? Our collaborative research development over the past 5 years, cross-institutionally and cross-culturally, in positive psychology (e.g., optimization: Phan et al., 2019c , 2020c ) has led to our keen collective interest to consider a proposition of a holistic model of mindfulness. At the time of preparation and write-up of our book, titled “ Teaching , Learning and Psychology ,” we briefly introduced this holistic model and contended that it offers a more inclusive definition of mindfulness. Our proposed model, as shown in Figure 2 , is innovative and differs from existing representations that largely emphasize the importance of Western ideas and theoretical stance (e.g., Baer et al., 2008 ; Sauer et al., 2011 ; Kabat-Zinn, 2015 ).

Conceptualization of holistic model of mindfulness.

The Importance for More Inclusiveness

Literatures delving into Confucianist teaching ( Yao, 2000 ; Havens, 2013 ) and Buddhist philosophy ( Yeshe and Rinpoche, 1976 ; Master Sheng Yen, 2010 ) have so much to offer, especially in terms of providing theoretical understanding into the nature of mindfulness. Many scholars, from Eastern contexts, would argue that existing research development into the nature of mindfulness from Western settings is somewhat limited. Psychological emphasis (e.g., state of relaxation), alone, is restricted and does not take into account the gamut of factors and/or facets that could illuminate the true “essence” of mindfulness. Having said this, however, we do note that in recent years, some Western scholars (e.g., Carmody, 1984 ; Carmody et al., 2008 ; Mutter, 2014 ; Lazaridou and Pentaris, 2016 ) have incorporated and have placed emphasis on non-psychological entities – for example, the importance of spirituality within the realm of mindfulness. Our own research development and professional experiences (e.g., teaching mindfulness at university), for example, have led us to strongly advocate for the inclusion of attributes that espouse to the teaching of Confucianism ( Yao, 2000 ; Havens, 2013 ) and Buddhism ( Yeshe and Rinpoche, 1976 ; Master Sheng Yen, 2010 ). In this analysis, meaningful understanding of mindfulness does not simply entail, for example, the experience of and appreciation for a relaxed state of mind. It is much more than this viewpoint, we believe. By the same token, not appearing to sound restrictive (e.g., restricting to Buddhism alone), we speculate that other specific epistemologies, philosophical beliefs, and rationales (e.g., faith in Hinduism) may also help to elucidate and add clarity to the study of mindfulness. In this analysis, we purport for a more holistic outlook by which different cultural interpretations could be offered to describe and explain the “totality” of mindfulness.

As shown in Figure 2 , our proposition indicates intricacy and that, more importantly, there is the “merging” of both Western and Eastern ideas. This consideration, indeed, rejects the view that mindfulness is simply a psychological entity. Similarly, in line with this reasoning, we recently devoted a chapter in our forthcoming book, titled “ In search of sociocultural and psychological explanations of human agency: Western and Eastern insights for future development ,” which seeks to explore the complex issues of methodology. In other words, as we explore later in the article, the methodological issue of measurement and assessment is imperative, especially in terms of empirical validation of the proposed model of mindfulness.

Proposed Model of Mindfulness

A model of mindfulness that is more inclusive, as shown in Figure 2 , may espouse both Western (e.g., Baer et al., 2004 ; Davis et al., 2009 ) and Eastern ( Nyanaponika Thera, 1972 ) ideas and theoretically-derived tenets. In this analysis, via means of focus-group discussions with Taiwanese scholars who specialize in knowledge, experience, and teaching of Asian cultural studies (e.g., Chinese History), mindfulness, and meditation, we theorize and postulate three components: psychological component , philosophical component , and spiritual component . This conceptualization, in particular, purports that mindfulness is much more than just testament of a person’s observational state of cognition and/or behavior. Our main premise is that, unlike research studies in Western contexts, there are many “non-observable” attributes, which may define mindfulness. In this analysis, we contend that Likert-scale measures and/or open-ended surveys, alone, do not capture the essence of mindfulness.

So, what is our proposition? Table 2 , referenced from Phan and Ngu’s (2019) recent publication, provides a summation of description of the three components and their respective attributes:

A Summary of psychological component, philosophical component, and spiritual component.

• • Psychological Component : concentration, relaxation, non-judgment, and self-awareness.
• • Philosophical Component : non-dualistic, ultimate reality, and rationality.
• • Spiritual Component : self-discipline, present moment, self-actualization, unity, and harmony.

In this analysis, we argue that mindfulness is rooted in a tripartite system of psychological, philosophical, and spiritual measures. In other words, we contend that this proposed tripartite system of mindfulness has both “scientific” (e.g., psychological measure?) and “non-scientific” (e.g., philosophical and spiritual measures?) measures, and may require engagement and usage of alternative non-traditional methodological approaches. In brief, as detailed in Table 2 , we have three components:

Philosophical Component

The philosophical component of mindfulness focuses on the epistemology and exploration of the contextual nature of mindfulness. Epistemology, in this case, is concerned with a persons’ quest to seek understanding into the true “meaning” of mindfulness. What does mindfulness actually mean and, more importantly, what does it constitute? This component of mindfulness, from our rationalization, delves into the reading of Buddhist scriptures and places emphasis on a person’s philosophical stance. In other words, we contend that individual experience of mindfulness, via means of meditation would direct and facilitate a person to engage in philosophical “pondering.” This “philosophical pondering” considers a person’s reflection and willingness to explore comparative and contrasting scenarios, viewpoints, and propositions.

A philosophical viewpoint of mindfulness, from our summation ( Table 2 ), emphasizes the importance of self-reflection, introspection, and contemplation. Experience of mindfulness, in this sense, delves into a person’s mindset and his/her relationship with nature and reality. For example, in his/her state of philosophical pondering, a person may contemplate about the universe and where he/she is at. Ultimately, the philosophical component of mindfulness espouses a perceived sense of openness, guiding a person toward appreciation for life and of life itself. In essence, the philosophical component of mindfulness has the potential to instill philosophical reasoning, enabling a person to question his/her own existence, contextual surroundings, and/or personal life experiences.

Aside from the mentioned testament, it is also a plausibility for a person to seek philosophical understanding about the nature of mindfulness. Philosophically, for example, what is mindfulness? What does it mean, theoretically, when a person is in a philosophical state of reasoning? Do we, as a specific being, differ from other beings and, more importantly, can we coexist? These few questions are examples, which may focus on the nature of the philosophical component of mindfulness. As physical beings, experiences of mindfulness enable us to question our own existence with nature and, by the same token, engaging in philosophical reasoning would permit us to acknowledge and recognize our own mortalities and rationalities.

Spiritual Component

The spiritual component of mindfulness focuses on the importance of spirituality . Spirituality, from an Eastern perspective, may encompass the true meaning of the afterlife and, of course, other life-related aspects that cannot be accounted for by the laws of physical sciences. The physical world, for example, defines a linear time point: past, present, and future ( Phan et al., 2020b ). We think about the past, live in the present moment, and consider our future outlooks. From this understanding, situated within a larger system of change, a person may seek to understand about his/her holistic being. What does this actually entail?

Experience of mindfulness, from our point of view, may enable a person to seek understanding into his/her presence in this universe. The physical body exists within the realm of a person’s lifetime – that is, from birth to death. However, spiritually, we also place emphasis on the “human spirit” or a “person’s soul.” From this understanding, we contend that experience of mindfulness would offer opportunities for individuals to reflect and to ponder about other “realms” of reality. Spiritually, a person could ponder and seek to understand the meaning of the afterlife – for example, what happens when a person moves on from this living world? Where does his/her soul reside? Where happens to his/her state of consciousness? These questions are examples that may reflect the complex nature of spirituality of mindfulness.

Self-awareness, indeed, is a state by which a person would seek to understand and appreciate. Personal self-awareness, in this case, would enable a person to situate his/her mindset to the present moment with the focus being on a quest to strive for enlightenment. Time, as we previously described, is an important entity by which only the present time point counts. In this sense, appreciation of spirituality enables a person to contemplate the meaning of peace, harmony, connectedness, and unity. By the same token, of course, experience of mindfulness would purposively allow a person to delve into the meaning of transcendence . Transcendence, in this case, is related to a person’s cognizance that there is a division between the living world and the non-living world.

Psychological Component

The psychological component of mindfulness focuses on the importance of a person’s psychological mindset. This emphasis, of course, closely relates to a person’s state of consciousness, delving into a few notable attributes – for example: (i) a person’s state of concentration, (ii) a person’s ability to remain non-judgmental, (iii) a need to be cognizant of the contextual surrounding and of himself/herself, and (iv) to recognize the importance of ease, calmness, and serenity.

In essence, the psychological component of mindfulness places emphasis on a person’s psychological mindset to be able to self-regulate his/her thoughts and behaviors. Experience of mindfulness, in this case, would enable a person to possess and exhibit an appropriate temperament, such as the ability to remain calm and to be non-judgmental of nature itself. In other words, from the perspective of Buddhism, mindfulness does not place emphasis on encouragement for individuals to make judgments and/or to be judgmental of others – for example, “that is a pretty dress that you are wearing.” Everything in nature is as it is and, importantly, there is no valence – that is, the positives versus the negatives.

Experience of mindfulness, psychologically, entails an unwaivered mindset by which a person is able to remain on task in terms of his/her attention. Recently, in a study involving Taiwanese university students, we introduced and explored a psychological concept, which we termed as “personal resolve.” Personal resolve differs from a state of resilience ( Martin and Marsh, 2006 ) and/or self-determination ( Deci and Ryan, 2008 ), and “considers interestingly the importance of a person’s mental resolute and “unwavering focus” to stay on task without any uncertainty or reservation to achieve optimal best. In this analysis, … personal resolve focuses on a person’s conviction that his/her choice, positioning, and action are indeed correct, despite what others may say” ( Phan et al., 2020c ). From this understanding, we contend that experience of personal resolve may indeed reflect the psychological nature of mindfulness, especially in terms of a person’s state of concentration.

In Totality: A Multifaceted Structure of Mindfulness

In total, what can we take away from the preceding sections? Our main premise, in this case, is that mindfulness is complex and may espouse a multifaceted structure, consisting of three major components: psychological, spiritual, and philosophical. This rationalization, in part, rejects existing research inquiries and theorizations from Western contexts, which place strong emphasis on different psychological themes. Stemming from personal experiences and the teaching of Buddhism and Confucianism, we argue that mindfulness is more than just testament and reflection of psychological processes (e.g., a person’s temperament). Rather, as a point of totality, we purport that perceived understanding of mindfulness encompasses the gamut of human experiences, consciously and subconsciously.

The distinction of our proposed model of mindfulness lies in its merging of Eastern and Western ideas, reflecting inclusiveness of philosophical, spiritual, and psychological attributes. At the same time, of course, we contend that our proposition places emphasis on the notion of “universality,” which encompasses both scientific (e.g., state of concentration) and non-scientific (e.g., state of transcendence) inquiries. This consideration emphasizes the use of personal reasoning and philosophical psychology to seek understanding into the intricate nature of mindfulness. By all account, the proposition detailed in Figure 2 , as Phan and Ngu (2019) recently introduced, is conceptual and would require rationalization and continuing research development. Speculative, however, it is plausible for us to draw in differences between individuals. For example, novice practitioners of meditation may simply experience an internal state of relaxation and calmness and, eventually, come to recognize the importance of his/her focus of concentration (e.g., on a subject). Novice learners of mindfulness, from our point of view, would not necessarily have the skills and/or experiences to reflect on their inner selves, and/or to view everyone with a sense of fairness. In contrast from this, more experienced practitioners of meditation (e.g., Buddhist monks/nuns) would have advanced understanding and appreciation of mindfulness, differentiating themselves by their achievements of enlightenment and satori . Moreover, advanced individuals of mindfulness would recognize the intricate “bond” between different beings and nature. An internal state of nirvana , in this case, would allow individuals to develop and flourish in different types of personal attributes, such as love, generosity, forgiveness, kindness, and respect for all different beings. In other words, in-depth and personal experience of mindfulness from our point of view may instill a higher-order “philosophical mindset,” resulting in a person’s appreciation and acknowledgment that there is no distinction and/or differentiation between different beings in nature (e.g., human beings, birds, dogs, etc.). In essence, from this testament, the significance of our proposed multifaceted model of mindfulness lies in understanding that a person’s experience of mindfulness may entail different types of philosophical, spiritual, and religious sentiments for contemplation – for example: what happens when a person passes on from this living world? what makes a person different from another person but, more importantly, should this “difference” affect his/her attitude, respect, viewpoint, etc. for that person?

Testament of Mindfulness as Part of Positive Psychology

By all means, development into the holistic representation of mindfulness, taking into account philosophical component, psychological component, and spiritual component is evolving ( Figure 2 ). What we have presented so far in this article is introductory, and entails the following:

• • Advocation for a complex, multifaceted structure of mindfulness, which reflects a combination of both Western and Eastern ideas. This emphasis is significant, advocating for the sharing of knowledge and the acceptance of cross-cultural comparison in viewpoints and epistemologies.
• • Consideration of consciousness and the subconsciousness and, by the same token, acknowledgment of both scientific and non-scientific attributes, which could account for the complex nature of mindfulness.
• • Acknowledgment that practice of meditation gives rise to a state of mindfulness, differentiating novice from experienced practitioners. Meaningful understanding of mindfulness, in this case, may consist of testament of evidence of philosophical experience, psychological experience, and/or spiritual experience.

It is sound and logical to consider mindfulness as an entity of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ). How do we rationalize this theoretical positioning – that mindfulness could be part of the repertoire of positive psychology? To answer this question, let us refer back to the concept of optimal best ( Martin, 2011 ; Liem et al., 2012 ; Phan et al., 2016 ) and, in particular, the active process of optimization ( Fraillon, 2004 ; Phan et al., 2019c , 2020b ). In a recent book chapter, Phan et al. (2019d) discussed this association in detail – that mindfulness could act as an optimizing agent, which would in turn facilitate the accomplishment of optimal best. We refer to Phan et al.’s (2019d) rationalization for discussion in this section. To assist with this postulation (i.e., the relationship between mindfulness and optimization), we have developed a conceptual model, as shown in Figure 3 .

Conceptualization of mindfulness and optimization.

The proposition detailed in Figure 3 is innovative, illustrating the potentiality for perceived experience of mindfulness to act as an antecedent in the process of optimization. As an example, with reference to Figure 3 , a person engages in Buddhist meditation, which would result in his/her understanding and experience of mindfulness – in this case, this understanding and experience of mindfulness is indicated by the person’s reflection, contemplation, and testament of true faith in the philosophy of Buddhism. We propose that this development in understanding and experience of mindfulness, in turn, would act to instill a suite of Buddhist-related attributes for acknowledgment and recognition – for example: personal contentment or satisfaction, the prosperity of health functioning, and a perceived sense of happiness, peace, and harmony. These Buddhist-related attributes, as positive and proactive concepts, from our conceptualization, may act as sources of information to initiate an appropriate level of energy, E, for further enactment ( Phan et al., 2019c , 2020b ). In accordance with recent development of the process of optimization, we postulate that a high level of energy would result in the activation and buoyancy of different psychological attributes (e.g., effort expenditure), resulting in arousal and the sustaining of a state of functioning (e.g., happiness).

The above example is insightful as it helps to elucidate the potential relationship between our proposed model of mindfulness and the paradigm of positive psychology ( Csíkszentmihályi, 1990 ; Seligman, 1999 ; Seligman and Csíkszentmihályi, 2000 ), which in this case is related to the process of optimization ( Fraillon, 2004 ; Phan et al., 2019c , 2020b ) and, subsequently, the achievement of optimal best. This depiction is summarized in Figure 4 where we have the following: (i) indicative of the paradigm of positive psychology is the achievement of optimal best (e.g., positive emotions), L 2 , and the process of optimization, and (ii) resulting from the process of optimization, which mindfulness may act as an optimizing agent, is the achievement of optimal best, L 2 , Our proposition, as shown, posits the indirect influence of mindfulness on optimal best, via the process of optimization. In other words, rather than a direct association (i.e., mindfulness ® optimal best), we argue that mindfulness is prevalent via means of its optimizing role.

Conceptualization of mindfulness and positive psychology.

Note: We have drawn a dotted line to depict the direct association between positive psychology and mindfulness. However, despite this recording, we propose that the relationship between the two concepts is evident via the process of optimization (i.e., non-dotted lines).

Implications for Consideration: Theoretical and Methodological Contributions

Scientific inquiries, such as research undertakings that focus on students’ academic performance outcomes are direct and may involve the use of conventional methodological approaches (e.g., a two-group experimental design). Complexities arise, however, when we have inquiries that do not conform to and/or situate within the physical world. In this analysis, measuring and assessing a psychological, factorial structure of mindfulness is relatively straightforward, which may involve Likert-scale responses that are analyzed within the framework of CFA techniques (e.g., Baer et al., 2004 , 2008 ; Cardaciotto et al., 2008 ). Having said this, though, validating our proposed multifaceted model of mindfulness is more difficult, to the point where it may be perceived as being improbable. Traditional methodological means, in this analysis, may not be adequate. For example, how would we validate the spiritual component of mindfulness? Understanding the true meaning of nirvana ( Phan and Ngu, 2019 ; Phan et al., 2019d ), in this analysis, is somewhat difficult to achieve, given the fact that it would be infeasible to quantify and measure.

In our recent research development, we devoted a chapter in which we explored in detail the issue of what is termed as “methodological appropriateness” ( Phan et al., 2019a ). Phan et al. (2019c) , in their conceptual article, introduced this term, which is defined as the development of an appropriate methodological design that would enable the accurate measurement and assessment of a process or an outcome (e.g., optimization). The authors’ rationale, in this case, is that inappropriate methodological designs would produce inaccurate results and/or misconstrued interpretations. On this basis, our chapter also explored the importance of appropriate methodological designs for usage to measure and assess non-scientific inquiries. In the present context, for example, emphasis of methodological appropriateness could involve the use of focus-group discussions and sharing of experience , in situ observations , and reflective writing to seek relevant insights into the multifaceted nature of mindfulness.

We perceive that certain aspects of our proposed model of mindfulness are “esoteric” and “mythological,” which would make it somewhat difficult to ascertain some form of scientific evidence. For example, experience of satori in which a person is able to reach a Buddha-nature state of tranquility would, in this sense, be difficult to validate. A perceived sense of satori, according to experienced practitioners of meditation, is “internalized” and not yield observational information for documentation. In a similar vein, testament of nirvana, that is a state of enlightenment, is somewhat difficult to document and to ensure accuracy for the purpose of comparison and consistency. Our mentioning of “non-scientific” attributes (e.g., the attribute of “ultimate reality”: Figure 2 ), in this case, emphasizes the importance of non-physical, non-contextual, and non-cognizant experiences.

We contend that at any moment in time, a person’s state of consciousness and engagement with the physical world serve to explain his/her experience of mindfulness. Personal experience, arising from maturity and ongoing practice of meditation, may provide grounding for individuals to develop “insights” into their sub-consciousness, enabling them to acquire esoteric and mythological experiences. Rather than focusing on conventional methodologies (e.g., a two-group experimental design), we propose the use of Eastern, non-traditional epistemologies, which could offer evidence and in-depth understanding of different personal esoteric experiences. Some Taiwanese colleagues that we know of, for example, engage in non-traditional epistemologies such as: (i) reflecting on their acquired wisdom about the world and life, in general, (ii) documenting their deep, meaningful insights into the living world, and (iii) to consider thoughts, behaviors, and actions that are “higher-order.” These methodological positionings, of course, are relatively unfounded and may lack credibility, scientifically. However, despite this contentious methodological approach, some Taiwanese scholars and experienced practitioners of meditation have attested to the fact that their esoteric, non-conventional experiences of mindfulness have helped them in their daily lives. In a similar vein, we recommend for the inclusion of contributions, theoretical, conceptual, empirical, and/or methodological, from other sociocultural settings. It would be of interest, in this analysis, for us to consider and incorporate other philosophical faiths – for example: how does true faith in Hinduism account for understanding and personal experience of mindfulness? how does an Indigenous group’s particular cultural esoteric practice assist in the development of understanding and experience of mindfulness?

Positive psychology, as extensive writings have shown, is an interesting paradigm for reading. At the same time, of course, educators and researchers have used positive psychology to structure and design various programs for implementation, which would ultimately result in the determent of pathologies as well as the promotion of positive conditions and positive life experiences. Our own research development over the past 5 years, likewise, has made extensive theoretical, methodological, and empirical contributions to the study of positive psychology. One notable aspect of our research, which we share in this article is the theorization and development of a proposed multifaceted model of mindfulness that takes into consideration both Western and Eastern ideas.

We contend that mindfulness is a complex concept that scopes different themes and attributes, scientifically and non-scientifically. Our theoretical contention, as explored in this article, is that mindfulness (i.e., our proposed multifaceted model) could coincide with and support the study of positive psychology. In particular, adhering to the theory of optimization, we postulate that mindfulness could act as an “optimizing agent,” which then would assist in the facilitation of a person’s achievement of optimal best ( Phan et al., 2017 , 2019d ; Phan et al., 2020b ). This consideration is interesting, reflecting our use of philosophical psychology, personal reasoning, and extensive experiences in teaching and research development of optimization and mindfulness. Aside from the postulation that mindfulness is closely associated with positive psychology, we also offer methodological issues that are of significance for continuing research.

Author Contributions

HP and BN were responsible for the conceptualization, literature search, and write-up of this manuscript. SC, LW, S-YS, R-YL, J-HS, and H-WW contributed equally in terms of conceptualization, discussion, literature search, and philosophical reasoning with specific reference to Buddhism and Buddhist mindfulness.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to extend our appreciation and gratitude to the editor and the two reviewers for their insightful comments.

1 https://chopra.com/articles/whats-the-difference-between-meditation-and-mindfulness

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Positive Psychology Interventions Reduce Anti-Rich Mentality: An Exploration of the Contribution of Appreciative Joy

• Research Paper
• Published: 30 March 2024
• Volume 25 , article number  38 , ( 2024 )

Cite this article

• Rong Wang 1 ,
• Ying Li 2 ,
• Yuan Zheng 3 ,
• Yang Zhang 3 ,
• Tian P. S. Oei 4 &
• Xianglong Zeng   ORCID: orcid.org/0000-0002-4793-7146 3  

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Studies in psychology and sociology have documented that anti-rich mentality is a threat to the stability of society and harms personal mental health, but few studies have investigated ways to intervene in anti-rich mentality. In the current work, we took an initial step to explore whether anti-rich mentality can be reduced by appreciative joy, a positive psychological concept that refers to feeling happy for others with an appreciative and unenvious attitude. A cross-sectional questionnaire survey in Study 1 ( n  = 632) first established a negative association between appreciative joy and anti-rich mentality. In Study 2, a randomized controlled trial further evaluated the effects of appreciative joy intervention ( n  = 499). The results showed that the intervention increased appreciative joy and decreased anti-rich mentality. Moreover, two concepts closely related to anti-rich mentality (i.e., perceived fairness in allocation and envy) were influenced by appreciative joy intervention. Our findings not only confirm the possibility of a positive psychology intervention to relieve anti-rich mentality but also highlight the effectiveness of appreciative joy in changing attitudes toward social groups. Implications for practices and prospects for future research are discussed.

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Data Availability

The datasets that support the findings of this study can be found via the following link: https://osf.io/qtwv4/?view_only=cf4ee1dcf82645beb63e223ef925bfc4 . Other research materials can be requested by contacting the corresponding author.

The positive emotion data were collected as part of our broader project, utilizing the Emotional Word List (Lee et al., 2013 ). Nine emotional words (e.g., happy and delighted) were rated on a 5-point Likert scale (1 = never; 5 = always; α = 0.89).

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This work was supported by the National Natural Science Foundation of China (No. 32200896), the Humanities and Social Sciences Youth Foundation, Ministry of Education of the People’s Republic of China (No. 21YJC190016), the Natural Science Foundation of Guangdong Province, China (No. 2022A1515011838), the Guangdong Philosophy and Social Science Foundation (Co-Building Project) (No. GD23XGL111), and the Shenzhen University Humanities and Social Sciences Revitalization Plan Project (No. WKZX0317).

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Yuan Zheng, Yang Zhang & Xianglong Zeng

School of Psychology and CBT Unit, Toowong Hospital, the University of Queensland, Brisbane, QLD, Australia

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Wang, R., Li, Y., Zheng, Y. et al. Positive Psychology Interventions Reduce Anti-Rich Mentality: An Exploration of the Contribution of Appreciative Joy. J Happiness Stud 25 , 38 (2024). https://doi.org/10.1007/s10902-024-00745-8

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ORIGINAL RESEARCH article

Positive parenting practices support children at neurological risk during covid-19: a call for accessible parenting interventions.

• 1 Department of Psychology, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
• 2 Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, Vancouver, BC, Canada
• 3 Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Children and youth with neurological and/or neurodevelopmental conditions were at high risk for behavioral and mental health challenges during the COVID-19 pandemic. Positive and responsive parenting practices may be one way to prevent and manage potential difficulties in families. We aimed to identify whether positive parenting practices were associated with reduced behavioral concerns in children at neurological risk during the late stages and aftermath of the COVID-19 pandemic. In addition, we examined whether ongoing parental stress, anxiety, and depression impacted parenting practices during this time period. Families ( N  = 179) with children 4 to 15 years old ( M  = 7.11y, SD  = 2.02) diagnosed with neurological (84.3%), neurodevelopmental (54.8%) or comorbid neurological and/or neurodevelopmental conditions (21.2%) were contacted to complete online questionnaires regarding demographics, parent stress, child behavior, COVID-19 conditions, and parenting practices. Multivariable linear regression (MLR) analyses examined the association between positive parenting practices and parenting competency measures with child behavioral outcomes, controlling for relevant covariates, including COVID-19 related stress. MLR were also run to determine whether parental mental health impacted parenting practices. More positive parenting practices predicted fewer child problem behaviors and lower intensity of problem behaviors. Similarly, a higher sense of satisfaction with parenting competence also predicted fewer child problem behaviors and lower intensity of problem behaviors. In addition, higher reported parental depression, anxiety, and stress significantly predicted fewer reported positive parenting practices. Findings points to the promising application of positive parenting interventions to support vulnerable families, as well as the need for parental mental health intervention to support parenting practices.

Introduction

The COVID-19 pandemic and associated restrictions introduced unprecedented challenges to families’ lives, including to physical and mental health, behavior, friendships, and education, with variability between developmental and sociodemographic groups ( Prime et al., 2020 ; Masten, 2021 ; Poulain et al., 2022 ). In general, children at high neurological risk (including those with early brain injuries, genetic conditions, or neurodevelopmental conditions such as Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder often face additional neurodevelopmental challenges such as higher rates of child behavioral problems and psychological distress ( Tak and McCubbin, 2002 ; Sikora et al., 2013 ; Bemister et al., 2014 ; Wiener et al., 2016 ; Williams et al., 2017 ). During and following COVID-19 specifically, children and adolescents with pre-existing neurological conditions (i.e., epilepsy, encephalopathy, early brain injury) were at a greater risk of behavioral and mental health deterioration—including but not limited to higher rates of anxiety, depression, and stress due to isolation ( Gassman-Pines et al., 2020 ; Bova et al., 2021 ; Williams et al., 2021 ; Zijlmans et al., 2021 ; Cost et al., 2022 ). Children with neurodevelopmental disorders showed the same patterns of detrimental effects on mental health due to the pandemic ( Conti et al., 2020 ; Guller et al., 2021 ; Masi et al., 2021 ), with as many as 40–50% of Canadian children impacted by emotional and behavioral difficulties, conduct problems and irritability Nonweiler et al., 2020 ; Cost et al., 2022 ).

Parents also faced mental health challenges during the COVID-19 pandemic: a meta-analysis involving nearly 9,000 participants revealed that mothers of young children (under the age of 5 years) experienced higher rates of clinically significant depression and anxiety symptoms during the pandemic ( Racine et al., 2021 ). The pooled prevalence rates for depression and anxiety were found to be 26.9 and 41.9%, respectively, indicating an increase compared to pre-pandemic estimates. Parental stress and mental health deterioration was found to negatively impact children’s behavior during the COVID-19 pandemic ( Shoychet et al., 2022 ). In line with the research conducted on the general population, children at neurological risk had greater COVID-19-related mental health deterioration when parents reported more mental health concerns ( Williams et al., 2021 ).

In addition to the children themselves, parents of children with behavioral and mental health challenges may also have difficulties coping with additional stressors ( Compas et al., 2017 ), including those further exacerbated by the pandemic ( Theberath et al., 2022 ). Prime et al. (2020) introduced the COVID-19 disruption model, suggesting that pandemic-related social disruptions negatively influence parental well-being, which subsequently impacts various aspects of family functioning. The identification of factors that reduce behavioral challenges and promote optimal function in this population is needed to inform appropriate interventions.

One factor that may positively impact children’s mental health in at-risk families is positive parenting ( Black and Lobo, 2008 ; Torres Fernandez et al., 2013 ; Daks et al., 2020 ; Guruge et al., 2021 ). Positive parenting includes parental flexibility, parental responsiveness, constructive parenting, and emotional warmth ( Tamis-Lemonda et al., 1996 ), and it can lead to more positive parent–child relationships – a well-established determinant of well-being in children ( von Suchodoletz et al., 2011 ; Seay et al., 2014 ; Weeland et al., 2021 ; Koper et al., 2022 ; Shoychet et al., 2022 ; Wang et al., 2022 ; Yates and Mantler, 2023 ). For example, positive parenting practices with children with ADHD can act as a protective factor against conduct problems ( Chronis et al., 2007 ; Healey et al., 2011 ; Dvorsky and Langberg, 2016 ). The extent to which these positive parenting factors were associated with optimal behavioral outcomes in children at neurological risk during the COVID-19 pandemic remains largely unexplored.

One COVID-19 specific study found that teaching parents how to engage with their children through acts of kindness, developing trusting relationships, and responding with compassion increased parent–child resilience during the pandemic as measured by parental resilience and parent-reported child empathetic prosocial behavior levels ( Johnson et al., 2022 ). Studies of children with neurodevelopmental disorders, such as autism spectrum disorder and intellectual disabilities, showed that positive parenting enhanced pandemic resilience, as measured by a family quality of life and parent–child relationship questionnaires ( Bolbocean et al., 2022 ). However, no studies have looked at whether positive parenting can specifically impact children’s behavior in a sample of children at neurological risk (i.e., preterm birth, brain injuries, pediatric stroke) and/or neurodevelopmental (i.e., learning disabilities, autism, ADHD) during and immediately following the COVID-19 pandemic, and whether parental mental health impedes positive parenting practices.

Identifying potential protective factors, such as parenting practices, that promote positive behavioral outcomes during times of increased stress are essential for informing targeted interventions for vulnerable families. In addition, it is important to consider factors that contribute to or impede effective parenting practices. Therefore, this study aimed to examine (1) whether self-reported positive parenting practices were associated with fewer child behavioral challenges during the COVID-19 pandemic amongst an at-risk neurological and/or neurodevelopmental Canadian sample. Secondly, we examined (2) whether self-reported parental mental health was associated with parenting practices.

Research design

Participants were recruited from three larger studies if they had consented to future follow-up for research: the first study (REB #1000054921) was an observational study of parents of children with neonatal brain injuries to examine factors related to parent stress and well-being. The other two studies (REB #1000072960 and #1000063660) were pilot studies for a virtual positive parenting intervention targeting child behavior and family well-being (I-InTERACT-North). All three studies were reviewed and approved by the Research Ethics Board at The Hospital for Sick Children. Recruitment and data collection took place between March 2022 and January 2023.

Consenting parents were forwarded online questionnaires via REDCap ( Harris et al., 2009 ), a secure web application housed on a secure server.

Participants

Recruitment and data collection took place between March 2022 and January 2023. Participants were parents of children with neurological and/or neurodevelopmental conditions who were followed at The Hospital for Sick Children or part of the Province of Ontario Neurodevelopmental Disorders Network (POND).

Neurological conditions included those related to early brain injury and associated medical conditions, such as stroke, hypoxic ischemic encephalopathy (HIE), prematurity, epilepsy, and congenital heart disease (CHD). Neurodevelopmental conditions included attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Patients with neurological conditions often had co-occuring neurodevelopmental conditions. Consenting parents were forwarded online questionnaires via REDCap ( Harris et al., 2009 ), a secure web application housed on a secure server. Exclusion criteria from prior studies included child age of less than 3 years or major medical issues requiring ongoing inpatient care (e.g., significant surgical or inpatient treatment).

A total of 305 families were invited to complete the follow-up questionnaires between March and October 2022. Families ( N  = 179) who completed the surveys during this data collection period were included in analyses. The final sample consisted of predominantly English-speaking, European, college/university-educated, and two-parent households. The children in these families were between 4 and 15 years old ( M  = 7.11y, SD = 2.02y; see Table 1 ) at the time of questionnaire completion. Thirty-eight children (21.2%) had comorbid neurological and/or neurodevelopmental conditions; both stroke (24.0%) and ADHD (24.6%) affected one-quarter of this population.

Table 1 . Family demographics and child clinical characteristics.

Demographics questionnaire

A comprehensive questionnaire was used to collect child and parent demographic information and child clinical information. Race and cultural heritage data was reported according to updated categories proposed by Canadian Census data and the Canadian Institutes of Health Research ( Canadian Institute for Health Information, 2022 ). To accommodate for those of multi-ethnic origins or identities, the total number of responses were greater than the total number of participants ( Statistics Canada, 2021 ). Neurological and neurodevelopmental-relevant medical data were collected through medical chart reviews, where available, and through parent report of child diagnostic history (open ended text box).

COVID-19 questionnaires

A subset of questions from the CoRonavIruS Health Impact Survey (CRISIS) V0.1 Parent/Caregiver Baseline Form and the CRISIS Adult-Self Report Baseline Form ( Nikolaidis et al., 2021 ) were included in the background questionnaire to assess social and financial impacts of the pandemic on families. The CRISIS questionnaire, designed by an international collaboration, examines mental health during the COVID-19 pandemic for families of children with neurodevelopmental conditions and has been used in larger COVID-19 studies ( Hawke et al., 2020 ; Nikolaidis et al., 2021 ; Cost et al., 2022 ). The original Parent/Caregiver baseline survey includes 98 questions regarding child wellbeing and mental health, and the original Adult-Self Report baseline survey includes 99 questions about parent wellbeing and mental health during COVID-19 and the impact of specific stressors (e.g., social isolation, COVID-19 economic concern, changes in relationships and positive changes related to the pandemic). The survey was adapted and abbreviated to 14 questions regarding the parent and 11 for the child based on feedback from our family advisory team in effort to reduce participant burden (e.g., reduce time to complete questionnaire and redundancy in questions). A 7-item subscale of the COVID Family Stressor Scale ( Prime et al., 2021 ) asked parents to report on COVID-19-related family stress and changes in the home (α = 0.82). Each item is rated on a 3-point scale of not true, somewhat true, and very true where higher sum scores indicate greater family stress related to COVID-19 changes in the home.

Parent sense of competence

The Parenting Sense of Competence Scale (PSOC; Johnston and Mash, 1989 ), a 17-item parent-reported survey measuring parents’ sense of confidence in their ability to parent children aged 2–9 years old, was used to assess self-reported parenting competence. Sample statements include “I meet my own personal expectations for expertise in caring for my child” and “Being a parent makes me tense and anxious,” each rated on a six-point scale ranging from 1 (strongly disagree) to 6 (strongly agree). An efficacy score is calculated using 9 items, and a satisfaction score is calculated using 7 items. A higher score indicates a greater sense of parenting efficacy or satisfaction. The PSOC has appropriate test–retest reliability, ranging between 0.73–0.74 and internal consistency (α = 0.80; Ohan et al., 2000 ).

Parenting practices

An abbreviated version of the 2014 Ontario Child Health Study’s Parent Practices Scale (PPS; Boyle et al., 2019 ) was used to assess frequency of positive and negative parenting practices. The modified PPS consists of 12 parent-report questions with Likert-item response options ranging from 1 (not at all) to 5 (more than 10 times) and asks parents to report the frequency of various parenting practices over the past six months. This scale specifically focuses on parenting behaviors, rather than beliefs, and asks questions pertaining to aspects of parental support and engagement (i.e., listening to child’s ideas, responsivity, presence), as well as hostility and coercion (i.e., threatening punishment). A higher score indicates greater positive parenting. The PPS has appropriate test–retest reliability (α = 0.81; Prime et al., 2021 ).

Child behavior

The Eyberg Child Behavior Inventory (ECBI; Eyberg and Pincus, 1999 ) was used to assess child behavior concerns. The ECBI is a 36-item parent-reported measure that assesses the frequency and severity of a child’s current problematic behavior in the home on a seven-point intensity scale and yes/no problem scale. The ECBI yields a total problems T score (“Is this [behavior] a problem for you?”; clinical cut-off T-score = 60) and a total intensity T score (“How often does this [behavior] occur?”; clinical cut-off T-score = 60). The ECBI has good test–retest reliability, ranging from 0.75 to 0.86, appropriate internal consistency (α = 0.94), and is sensitive to effects of family treatments ( Funderburk et al., 2003 ).

Parent mental health

The Depression and Anxiety Stress Scale (DASS; Lovibond and Lovibond, 1995 ; Antony et al., 1998 ) was used to assess self-reported symptoms of parent stress, depression, and anxiety. The DASS consists of 42 items that are equally divided among three different scales: depression (α = 0.97), anxiety (α = 0.92), and stress (α = 0.95). Each item is rated on a scale from zero (never) to three (almost always) where higher scores indicate more severe symptoms of depression, anxiety, or daily stress. On the DASS-21, a summary score ≥ 13, ≥ 9, or ≥ 18 indicates elevated parenting depression, anxiety, or stress, respectively.

Demographic variables were analyzed using cross tabulations, means and standard deviations. All relationships between variables of interest, including predictors, outcomes, and covariates, were analyzed using a series of correlations. Multivariable linear regression analyses were run using parenting competence and practice measures as predictors and child behavior and child mental health as dependent variables. Possible covariates included stress due to COVID, parent age, child age, parent culture, gender, marital status, number of siblings, birth order, parent education, whether the child had a medical diagnosis, and whether the child had a neurodevelopmental disorder. Covariates were retained in the model only if they had a p-score equal to or less than 0.2 and/or changed the predictor beta coefficient by more than 10% when included. Final covariates are described in the results. We also considered possible interaction terms by COVID-related family stress and parental mental health, which may influence the relationship between parenting and child behavior. We controlled for multiple comparisons using the Bonferroni method by taking the number of tests and dividing by the alpha value. In addition, we examined whether parental mental health predicted parenting practices by regressing PPS by parental stress, depression and anxiety, controlling for covariates, including COVID-stress.

Participants profile

Overall, child behavioral scores were slightly elevated, and mean parental mental health scores were within average score ranges; however, there was wide variability in scores.

The most common child condition reported in our sample was ADHD, followed by acquired brain injuries such as stroke, HIE, and CHD; less frequently reported conditions in our sample included epilepsy, ASD, and global developmental delay ( Table 1 ). Many families reported multiple diagnoses, most commonly ADHD, along with a neurological condition, such as stroke ( Table 1 ).

COVID-19 descriptives

Within our study sample, the majority of parents retained their jobs during the pandemic and continued with 8% reporting experiencing financial difficulties and 6% reporting feeling ‘very’ or ‘extremely’ worried due to their living situation. About 30% of families reported receiving funds from COVID-19 government relief programs. The majority of families (61%) reported slight to moderate levels of stress when it came to taking care of their child, their education and daily activities during COVID, and 24% reported extreme levels of stress. However, 47% of families still reported that COVID had a positive change in their lives.

Positive parenting practices, child behavior, and mental health

Overall, child behavioral scores were slightly elevated ( Table 1 ) and mean parental mental health scores were within average score ranges ( Table 2 ); however, there was wide variability in scores. The majority of behavioral problems endorsed included non-compliance (i.e., refusing to listen), exhibiting temper tantrums (including yelling), and difficulty concentrating and finishing tasks. On open-ended responses on questionnaires parents most frequently endorsed their children’s challenges with emotional regulation (i.e., tantrums, meltdowns) and organizational skills (i.e., task planning, taking initiative).

Table 2 . Predictors of child behavior problems and intensity during COVID-19 in neurologically at-risk children.

Table 4 . Parental depression, anxiety, and stress predicts positive parenting practices.

Parents rated themselves as having moderate to good parenting practices (PPS: M  = 40.68/53, SD  = 5.78); however, there was a large range of scores from very low (minimum: 21) up to a perfect score (maximum = 53). Higher reported positive parenting practices were strongly correlated with lower child behavior intensity ( r  = − 0.55), and moderately correlated with fewer behavioral problems ( r  = − 0.49). A moderate positive correlation was found between positive parenting and parenting competency [both efficacy ( r  = 0.41) and satisfaction ( r  = 0.43)]. Greater positive parenting practices had small to moderate inverse correlations with scores on parental depression ( r  = − 0.30), anxiety ( r  = − 0.17), and stress ( r  = − 0.40).

Child age, child gender, number of siblings in the home, and parent level of education had negligible associations with positive parenting practices, parental mental health, and parenting competency ( r  < ± 0.1). However, parental mental health had low to moderate correlations with reported financial strains during the pandemic ( r  = 0.24–0.37), and therefore we retained this variable for regressions. Additionally, COVID-related family stress was inversely and moderately correlated with parenting competency, positive parenting, child behavioral problems, and parental mental health ( r  < − 0.24); therefore, it was also retained in analyses to determine whether parenting practices and/or parental mental health remained predictors after accounting for COVID-family stress. Parental mental health and COVID-related stress were not significant effect modifiers in regression analyses, both as continuous variables and dichotomized by clinical cut-offs.

Predicting child behavior

After controlling for covariates, higher positive parenting practices predicted fewer child problem behaviors ( B  = −0.889, p  < 0.001) and lower intensity of problem behaviors (B = −0.843, p  < 0.001; Table 3 ). Similarly, a higher sense of satisfaction with parenting competence predicted fewer child problem behaviors (B = –0.425, p  < 0.001) and lower intensity of problem behaviors ( B  = −0.477, p  = <0.001). A higher sense of parental competency was not significantly associated with behavioral outcomes.

Table 3 . Predictors of child behavior problems and intensity during COVID-19 in neurologically at-risk children.

Predicting positive parenting

After controlling for covariates, higher reported parental depression ( B  = −0.40, p  < 0.001), parental anxiety ( B  = −0.51, p  < 0.001), and parental stress ( B  = −0.42, p  < 0.01) significantly predicted fewer reported positive parenting practices ( Table 4 ).

The COVID-19 pandemic and its aftermath was a very stressful period for Ontario families. School closures, loss of social, therapeutic, and recreational activities, as well as loss and modifications to work environments led to significant changes in the lives of children and parents. Children with pre-existing conditions were at elevated risk for behavioral and mental health challenges during the pandemic ( Cost et al., 2022 ), and studies have demonstrated the scope of children affected, which include neurological and neurodevelopmental populations ( Williams et al., 2021 ). In the present study, we aimed to explore positive parenting as a potential mitigating factor for behavioral challenges faced by families of children with neurological and/or neurodevelopmental disorders during the later stages of the COVID-19 pandemic and its aftermath.

We found that self-reported positive parenting practices and reported parenting competence were predictive of lower child behavior problems and reduced intensity of those problems. Specifically, the more positive parenting practices endorsed (i.e., listening to child, responding to child) was associated with fewer behavioral concerns (i.e., less yelling, fewer tantrums, following directions), as well as a lower intensity of these problems (i.e., less severe tantrums and melt downs). As well, a higher degree of parenting competence (i.e., meeting one’s own parenting expectations, feeling less tense in parenting) was also associated with fewer behavioral problems and a lower intensity of these problems mentioned above. In addition, we found that poorer reported parental mental health (i.e., more symptoms of depression, anxiety, stress) was associated with fewer positive parenting practices (i.e., threatening punishment, less responsivity).

Overall, our findings are consistent with previous studies of children with ADHD and non-clinical samples, where parenting stress negatively impacted parenting style, and was related to child impairment, externalizing behaviors and poorer overall functioning ( Cina et al., 2011 ; Healey et al., 2011 ; Flannery et al., 2021 ; Okorn et al., 2022 ). While other studies have demonstrated the relationship between positive parenting, behavior, and parental mental health, our study included children and families with pre-existing neurological and neurodevelopmental conditions during the COVID-19 pandemic, who have been shown to be specifically at a high risk for behavioral and mental health challenges generally, and even more so during the pandemic ( Conti et al., 2020 ; Guller et al., 2021 ; Masi et al., 2021 ). Therefore, identifying protective factors to mitigate these challenges is even more important in these populations.

We found that positive parenting skills may serve as a modifiable target for child and family mental health interventions in order to mitigate declines in mental health and behavior when unforeseen circumstances (i.e., COVID-19 pandemic) occur. Our study demonstrated that the relationship between positive parenting and behavior remained strong even after considering factors such as, parental level of education and COVID-19 related family stressors, highlights the potential of positive parenting and family wellness to be able to supersede even the crises and lack of services during the pandemic. Considering that some studies have shown that level of parental education impacts aspects of positive parenting ( Planalp et al., 2022 ), it is important to design interventions that can be accessible and relevant to all families.

In considering the limitations of the current study, it is important to note that all data used in this study to describe child behavior, child mental health, parenting skills, and parenting competency were collected at one time period and focused solely on parent report data. A previous study on parent affect during COVID-19 leveraged the child’s perspective by recruiting older children ( M  = 10.5y; Chu et al., 2021 ) to complete modified questionnaires as a means of engaging multi-informants. Similar efforts to understand children’s experiences may be helpful in future studies. Given that this is a cross-sectional design, future research may benefit from longitudinal approaches to assess whether parental stress and mental health, as well as child behavior, precede parenting practices or vice versa. Future research on associations with parenting competence would also benefit from a validated scale for children older than 9 years; however, in the present study, we repeated analyses using the PSOC scale while excluding children aged 10–15 years, and results did not change. It is possible that parents of children with fewer behavioral challenges indicate more positive parenting due to fewer challenges in their children’s behavior. Future studies may wish to consider parenting and behavioral associations amongst different age groups and whether there are differences within age-specific stratifications.

In addition, in our study, families tended to consist of higher socioeconomic status and older age, consistent with the demographic of research cohorts ( Henrich et al., 2010 ). Participants in our sample had also participated in previous research studies on parent mental health and well-being, which may have inflicted bias on their responses if they had an idea of the research objectives. Previous research has shown that these qualities tend to exist in families with better social support ( Smith et al., 2010 ); future research may wish to consider a more socioeconomically diverse sample and other diversities not represented in our sample.

Future implications and clinical considerations

In the unpredictable post-pandemic era, when many environmental factors, such as sociodemographic considerations and previous neurological morbidity, are largely out of parents’ control, the results of this study point to positive parenting as an intervening factor that may have the potential to improve child behavior. In fact, healthcare providers are calling for early interventions to encourage adaptive family relationships ( Garner and Yogman, 2021 ; McCrae et al., 2021 ). Interventions that help parents cultivate positive relationships with their children, respond to their children’s behavior, and protect their own mental health during times of stress may increase positive parenting and parents’ sense of competence in responding to behavioral concerns. One such example that is applicable to families with medical and neurological backgrounds is the I-InTERACT-North program, which we co-designed to provide virtual, incremental, and individualized 1:1 therapy and coaching for parents of children with neurological challenges ( Deotto et al., 2023 ). I-InTERACT-North was developed as a virtual intervention prior to the COVID-19 pandemic ( Burek et al., 2020 ), and was delivered continuously throughout ( Deotto et al., 2023 ). The results of the present study support emerging research showing that increasing positive parenting is associated with a lower frequency and intensity of child behavioral problems, specifically in vulnerable populations. It is imperative that programs, such as the I-InTERACT-North program, reach families of all backgrounds. Investments in the early years to reduce problematic outcomes must be a priority, and must be accessible to all families, especially those that may be less likely to access these supports ( Garner and Yogman, 2021 ; McCrae et al., 2021 ). Specifically, parents of children with medical needs have indicated they want support after receiving information on neurodevelopmental and psychiatric vulnerability ( Perlman et al., 2023 ). Indeed, the World Health Organization guidelines call for increased availability of parenting interventions to prevent poor treatment and enhance parent–child relationships World Health Organization (2022) . Decades of research have shown that identifying and intervening as early as possible to prevent the occurrence or worsening of mental health sequelae in childhood is the best way to offset mental health disorders in adulthood. Given global threats and complex emergencies, and considering that pandemic-related risks may disproportionately hit children and families who are already disadvantaged ( Fegert et al., 2020 ), we must be better prepared to address the major mental health challenges of the next several decades, and one way is through offering early interventions to promote resilience. Integrating early interventions through clinical care could optimize parenting and strive to prevent the onset of mental health sequelae.

Parenting can be challenging, especially for children with unique needs. Parenting was exacerbated by the pandemic, with the lack of social support and the heightened state of fear and anxiety interfering with routine and practice. In our sample of neurologically and neurodevelopmentally diverse Canadian children, positive parenting helped to reduce challenging behaviors. It is our hope that positive parenting interventions can be accessed by all families and be leveraged to promote optimal mental health and well-being.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by the Hospital for Sick Children Research Ethics Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

RG: Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. JL-E: Data curation, Formal analysis, Project administration, Writing – original draft, Writing – review & editing. CG: Formal analysis, Writing – original draft, Writing – review & editing. MT: Writing – original draft, Writing – review & editing, Formal analysis. GF: Data curation, Project administration, Writing – original draft, Writing – review & editing. SM: Supervision, Writing – original draft, Writing – review & editing. TW: Conceptualization, Methodology, Supervision, Writing – original draft, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by a Canadian Institutes of Health Research (CIHR) Operating Grant [FRN: 178854] and a combined COVID-19 Grant from the Garry Hurvitz-Centre for Brain and Mental Health and Edwin S.H. Leong Centre for Healthy Children.

Acknowledgments

The authors acknowledge the support of our participants, parent advisors, and therapists. The authors would also like to thank the POND Network and the Neonatal Follow-up Clinic and Neurology teams at the Hospital for Sick Children for their support.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: positive parenting, family well-being, neurodevelopmental conditions, neurological conditions, mental health

Citation: Green R, Linga-Easwaran J, Goodman C, Taylor M, Fabiano GF, Miller SP and Williams TS (2024) Positive parenting practices support children at neurological risk during COVID-19: a call for accessible parenting interventions. Front. Psychol . 15:1328476. doi: 10.3389/fpsyg.2024.1328476

Received: 26 October 2023; Accepted: 28 March 2024; Published: 08 April 2024.

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Copyright © 2024 Green, Linga-Easwaran, Goodman, Taylor, Fabiano, Miller and Williams. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Rivka Green, [email protected]

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